Nursing Reports

Background: Examining the relationship between burnout and absenteeism is important for understanding how chronic occupational stress translates into economic costs, reduced productivity, and deterioration in the health of nursing staff. The aim of this study was to evaluate absenteeism among nursing staff and its association with burnout from a gender perspective. Methods: A total of 154 nursing professionals with permanent contracts were included. An interview was conducted, which included the collection of sociodemographic data, characteristics related to their employment status, and the Maslach Burnout Inventory questionnaire in its Spanish-validated healthcare personnel version. The absenteeism rate was calculated using information from the hospital’s human resources department. The Mantel–Haenszel test was used to identify the association between burnout and absenteeism from a gender perspective. A p-value < 0.05 was considered statistically significant. Results: The prevalence of burnout was 70.1%; 52.6% reported absenteeism in 2024. The general nursing category was significantly associated with burnout (p = 0.039). Although no association was found between burnout and overall absenteeism, holding multiple jobs was identified as a determinant of partial absenteeism (p < 0.05). The hospital absenteeism rate was 4.8%. No statistically significant difference was found between burnout, gender, and absenteeism, with an adjusted odds ratio of 1.386 (95% CI: 0.75–2.65) after controlling for the effect of gender (χ²_MH = 0.672, df = 1, p = 0.412). Conclusions: Nursing staff present a critical level of burnout. No statistically significant difference was found between burnout, gender, and absenteeism, which could indicate that gender roles in the workforce may be changing in our population. Full article

Background: Professional identity (PI) formation is a central developmental process associated with students’ well-being and ability to cope with professional demands. Healthy lifestyle (HL) and self-care are recognised as resources for sustaining long-term professional engagement. Although both PI formation and HL are considered important in nursing education, their interrelationship remains insufficiently understood. Objective: This review aimed to map and synthesise the existing literature on nursing students’ PI formation and its relationship with HL. Methods: A scoping review was conducted following the Arksey and O’Malley framework, Joanna Briggs Institute guidance, and PRISMA-ScR reporting standards. A systematic search was performed in Web of Science, Scopus, MEDLINE, and PubMed for peer-reviewed studies published 2015–2025. Results: Twelve sources met the inclusion criteria. The relationship between PI and HL is complex, indirect, and not yet clearly conceptualised. Rather than being defined through direct behavioural pathways, it appears to be mediated through mental well-being and related psychosocial aspects, as well as contextual influences. Tensions were identified between expectations of nurses as health role models and students’ lived behaviours. A well-developed PI may function as a protective resource against maladaptive coping and support-adaptive responses to academic and clinical stress. Conclusions: Both PI and HL are predominantly conceptualised as dynamic and contextually embedded processes. More integrative approaches addressing both behavioural and psychosocial dimensions are needed. Future research should adopt conceptually coherent and methodologically balanced designs across diverse educational contexts. Full article

Background/Aims: Resilience is a protective factor that helps nursing students manage the challenges of clinical education. However, the relationships between resilience, clinical internship satisfaction, and psychological well-being remain underexplored. To examine the associations between resilience, satisfaction with clinical internships, and psychological well-being among undergraduate nursing students across academic years and campuses. Methods: A cross-sectional observational study was conducted. A total of 302 undergraduate nursing students from four campuses of a northern Italian university completed three validated instruments: the 14-item Resilience Scale (RS-14), the Clinical Learning Quality Evaluation Index (CLEQI), and the 12-item General Health Questionnaire (GHQ-12). Descriptive, correlational, and multiple regression analyses were performed. Results: Resilience was positively associated with clinical learning satisfaction and inversely associated with psychological distress. Regression models confirmed resilience as a significant predictor of both clinical satisfaction (p < 0.01) and psychological well-being (p < 0.05), adjusting for age and gender. Conclusions: Resilience plays a crucial role in improving both educational satisfaction and psychological outcomes in nursing students. Integrating resilience-building strategies into nursing curricula could enhance learning experiences and well-being. Full article

Background/Objectives: Contemporary healthcare systems are characterised by rapid change, high workload, and staff shortages, creating conditions that may compromise care quality and generate turbulence in nursing. Turbulence has been discussed in nursing research. However, greater conceptual clarity is needed regarding its underlying factors and implications for nursing work. The aim of this study was to explore and analyse the concept of turbulence in nursing and its related factors. Methods: The study was conducted using the Simultaneous Concept Analysis Method involving a consensus group and a nursing care, expert group and included content validity index ratings as a validation technique. Results: Eight factors related to turbulence in nursing were identified. A conceptual model was developed to illustrate the interrelationships among these factors and their role within the turbulence concept. Based on this model and the demonstrated contextual interconnections, a comprehensive definition of turbulence in nursing was formulated. Conclusions: The study has achieved a deeper understanding of the concept “turbulence in nursing” through the identification of eight different, generally valid turbulence-related factors and their presumed impact on nursing care. A conceptual model of interacting forces in turbulence in nursing has been presented as both a detector and a compass for mapping and counteracting future tendencies toward turbulence in the work environment. The study enables healthcare professionals and leaders to detect and address emerging turbulence in nursing practice and education. By clarifying its underlying major related sources, the model serves as a practical guide for improving the work environment, strengthening team resilience, and ultimately enhancing patient safety and quality of care. Full article

Background/Objectives: Professionalism reflects an individual’s connection, identity, and dedication to their profession. In nursing, it is associated with quality of care and professional respect, making its assessment essential for workforce development and management. However, valid and reliable instruments are needed to measure this construct across cultural contexts. Therefore, this study aims to evaluate the validity and reliability of the Portuguese version of the Nurses’ Professionalism Inventory (NPI). Methods: This methodological study used cross-sectional data collected from November 2024 to January 2025 in northern Portugal. Data were gathered from a convenience sample of 684 nurses who completed a sociodemographic questionnaire, the Portuguese NPI, the Conditions of Work Effectiveness Questionnaire II (CWEQ-II), and the Team Psychological Safety (TPS) scale. Confirmatory Factor Analysis (CFA) was conducted. Factor loadings and Average Variance Extracted (AVE) were used to assess validity. Internal consistency was evaluated using Composite Reliability, McDonald’s omega, and Cronbach’s alpha. Convergent validity was examined using Spearman correlations among NPI subscales, CWEQ-II dimensions, and TPS. Results: The Portuguese version of NPI preserved the original five-factor structure. The model showed acceptable fit indices (TLI = 0.90; CFI: 0.91; RMSEA = 0.10; SRMR = 0.08). All items had factor loadings above 0.50, except item 18 (0.42), which did not load significantly on any other factor; therefore, it was removed. This improved the AVE of the Professional Attitude subscale. The overall internal consistency was satisfactory, with all reliability coefficients ranging between 0.73 and 0.99. The correlations among the NPI subscales, CWEQ-II dimensions, and TPS were positive and statistically significant. Conclusions: This study demonstrates adequate measurement properties of the Portuguese version of NPI, supporting its use as a valid and reliable instrument. Full article

Background: Nurses’ motivation is essential for ensuring the quality of care and workforce retention. Understanding the underlying psychological mechanisms is essential, particularly through Self-Determination Theory (SDT). This approach clarifies how work environments influence work engagement and performance. Existing research has explored SDT in various contexts. However, little is known about how contextual and organizational factors specifically impact nurses’ motivation in low- and middle-income countries such as Morocco. This study contributes to addressing this gap. Objectives: This study explores how organizational factors within a Moroccan university hospital influence the BPNs’ satisfaction in a Moroccan teaching university hospital. Methods: An exploratory qualitative case study was used. Purposive sampling was used to select 26 participants, including nurse managers (n = 7), rehabilitation therapists (n = 5), pharmacy technicians (n = 4), nurses at the Hematology Department (n = 4), nurses at the Emergency Department (n = 4), and nurses in the outpatient consultation unit of the Otorhinolaryngology Department (n = 2). Data collection was conducted from March to June 2023, following ethical approval. Data analysis followed Yin’s five-step process, incorporating deductive and inductive coding, within- and cross-case thematic analysis, and iterative explanation-building. Results: Identified motivation emerged as the most frequently reported type, although BPNs’ satisfaction varied. Rehabilitation therapists consistently reported high levels of autonomy, competence, and relatedness, which were attributed to transformational leadership, task specialization, and a supportive organizational culture. In contrast, nurses experienced role ambiguity, transactional leadership, excessive workloads, and limited autonomy in decision-making, all of which contributed to unmet BPNs. Performance evaluations and financial incentives were widely perceived as unjust. Conclusions: This study shows that in LMIC hospital settings, nurses’ motivation depends on organizational support for their BPNs, especially in resource-constrained environments. The significant disparities between professions within hospitals indicate that supportive environments with autonomy-supportive leadership, clear roles, fair evaluation, and adequate staffing are both achievable and essential for motivating and retaining nurses. Full article

Background/Objectives: In the context of nursing research and interventions, caregiver preparedness emerges as a pivotal concept. Informal caregivers play a central role in providing older adults with the vital nursing and social support they require. The present study evaluated the psychometric performance of the Caregiver Preparedness Scale (CPS) and tested the hypothesis that CPS scores differentiate between theoretically relevant known groups, including caregiving exposure and relationship-based indicators. Methods: A cross-sectional, face-to-face survey was conducted in June 2025 among the general population of Czechia. A total of 1024 interviews were included in the analysis. The sample was randomly split for exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The internal consistency of the scale was assessed using Cronbach’s α and McDonald’s ω, while inter-item associations were evaluated with Kendall’s tau-b. The known-groups validity was assessed through nonparametric group comparisons across caregiving exposure, relationship indicators within the caregiver–senior dyad, caregivers’ self-rated health, and their life satisfaction. Results: The CPS demonstrated high internal consistency (Cronbach’s α = 0.944; McDonald’s ω = 0.944), robust item–total correlations (0.730–0.863), and acceptable floor and ceiling effects. The EFA supported a dominant one-factor solution (eigenvalue = 5.749), which explained 71.9% of the variance and had strong loadings (0.750–0.894). The CFA demonstrated a good fit (RMSEA = 0.069, SRMR = 0.0155, CFI = 0.990, and TLI = 0.980) after allowing for a limited number of conceptually justified residual covariances. Known-groups analysis supported the sensitivity of the scale when the CPS scores were higher among primary (M = 25.30) and secondary (M = 22.73) caregivers in comparison to non-caregivers (M = 18.38). Moreover, statistically significant differences were observed among those who provided care during the past five years (M = 24.30) compared to those without such experience (M = 18.12). CPS scores also exhibited variation in relationship-focused indicators in the anticipated directions, and were lower among respondents reporting poorer health and lower life satisfaction. Conclusions: The study provided consistent evidence that CPS is a reliable, unidimensional measure with robust known-groups validity. The CPS can be regarded as a suitable research instrument for nursing research and for evaluating interventions aimed at supporting informal caregivers. Full article

Background/Objectives: Parkinson’s disease (PD) is a progressive neurodegenerative disorder that affects both motor and non-motor functioning, leading to increasing dependency and long-term psychosocial consequences. As the disease progresses, partners often assume caregiving roles, resulting in shifts in responsibilities, communication patterns, and emotional dynamics within marital relationships. The aim of this study was therefore to explore the impact of Parkinson’s disease on marital relationships. Methods: A qualitative interview study with a retrospective design was conducted. Six couples were recruited through a movement disorders clinic and a lay organization in Sweden. Semi-structured, face-to-face interviews were conducted separately with each partner. Interviews were transcribed verbatim and analyzed using conventional content analysis with an inductive design. Results: Four main themes emerged: managing the disease together in partnership, nurturing the relationship, facing marital hardship, and planning an uncertain future. Couples who adopted a positive and pragmatic outlook, shared responsibilities, and maintained open communication seemed to be better able to manage the disease. Engaging in joint activities and reciprocal communication strengthened emotional closeness. In contrast, changes in roles, emotional distress, loss of intimacy, and communication avoidance challenged relationships. Thinking about the future evoked feelings of ambivalence, as couples balanced uncertainty with a need for security. Conclusions: Parkinson’s disease affects marital relationships, reshaping roles, emotional bonds, and future perspectives. The ability of nurses to address both partners’ needs and promote communication and shared coping strategies is essential to strengthening couples’ well-being. Full article

Background: Job satisfaction among nursing staff is a key determinant of workforce stability, quality of care, and healthcare system sustainability. Nurses are increasingly exposed to high workload, staffing shortages, and complex organizational demands, which may adversely affect satisfaction and retention. The aim of this study was to examine job satisfaction among nursing staff working across different levels of healthcare in Slovenia and to identify organisational and sociodemographic factors associated with job satisfaction. Methods: A cross-sectional quantitative study was conducted among nursing staff employed in Slovenian healthcare settings. Data were collected using an online questionnaire that included the Job Satisfaction Survey (JSS) and sociodemographic, occupational, and organizational variables. Differences in job satisfaction across professional groups were examined using non-parametric tests. Associations between job satisfaction dimensions and explanatory variables were analysed using Spearman’s correlation coefficients, and multiple linear regression analyses were performed to identify independent predictors of job satisfaction. Results: Organizational and workload-related factors emerged as the most consistent determinants of job satisfaction across all JSS dimensions and total satisfaction. Unclear job task definitions, high workload, insufficient staffing, continuous healthcare provision, unfavourable work schedules, and limited opportunities for rest were associated with lower job satisfaction. In contrast, financially compensated overtime, supportive supervision, higher perceived employer quality, longer tenure in the current position were associated with higher satisfaction in several domains. Sociodemographic variables showed weaker and less consistent effects after adjustment for organizational characteristics. Intentions to change jobs within or outside the healthcare system were strongly associated with lower satisfaction across nearly all dimensions. Conclusions: Job satisfaction among nursing staff is shaped predominantly by modifiable organizational factors rather than demographic characteristics. Interventions aimed at improving task clarity, staffing adequacy, work organization, leadership practices, and recovery opportunities may enhance job satisfaction and contribute to a more sustainable nursing workforce. Full article

Background/Objectives: Emergency Services (ESs) are highly demanding clinical settings where Nursing Practice Environments (NPEs) play a critical role in shaping professional- and care-related outcomes. International evidence suggests that unfavorable NPEs are associated with reduced job satisfaction, compromised care quality, and increased safety risks. This study aimed to describe NPEs and selected professional and care-related outcomes among ESs nurses in Portugal in 2018 and 2022. Methods: A descriptive, cross-sectional study was conducted using data from two national surveys of ESs nurses collected in 2018 (n = 390) and 2022 (n = 434). Data were collected through an online questionnaire including the Practice Environment Scale of the Nursing Work Index (PES-NWI), measures of job satisfaction, intention to leave, perceived quality and safety of care, safety culture, incident occurrence, and missed nursing care. Descriptive statistics were used to summarize results across both samples. Results: NPEs were predominantly classified as unfavorable in both samples, with around 70% of nurses working in unfavorable environments. The most compromised dimensions were staffing and resource adequacy, nurses’ participation in hospital affairs, and nurse manager ability, leadership, and support of nurses. Job satisfaction was low in both samples, and a high proportion of nurses reported an intention to leave the organization. Differences were observed between samples in perceived quality and safety of care, incident occurrence, and missed nursing care, particularly in relational and autonomous interventions. Collegial nurse–physician relations emerged as the only favorable dimension in both samples. Conclusions: The findings indicate that NPEs in Portuguese ESs were predominantly unfavorable in both study periods, reflecting structural and organizational challenges. These findings may be associated with nurses’ professional outcomes and perceived care quality and safety, highlighting the importance of targeted organizational interventions to improve practice environments. Full article

Background/Objectives: Inflammatory bowel disease (IBD) requires sustained self-care, yet patients’ ability to manage daily treatment and symptoms is often shaped by the support provided by informal caregivers. Methods: Guided by the Middle-Range Theory of Self-Care of Chronic Illness, this multicentre cross-sectional study described caregivers’ contributions to self-care maintenance, monitoring, and management in IBD, and compared these contributions between caregivers of patients with Crohn’s disease (CD) and those of patients with ulcerative colitis (UC). Results: A convenience sample of 275 caregivers of adult outpatients with IBD was recruited across multiple Italian centres. Caregiver contribution was measured using the Caregiver Contribution to Self-Care of Chronic Illness Inventory, together with caregiver self-efficacy and selected sociodemographic and clinical variables. Caregivers reported substantial involvement across all self-care domains, with significantly higher contributions to self-care maintenance among caregivers of patients with CD than among those caring for patients with UC. Monitoring and management scores were similar across groups. Regression analyses indicated disease-specific patterns, with caregiver gender, education, employment status, and patient clinical characteristics showing differential associations with self-care domains. Conclusions: These findings underscore the central role of caregivers in supporting self-care in IBD and suggest that structured, caregiver-focused approaches embedded in routine clinical pathways may strengthen dyadic chronic illness management. Full article

Background: It is well known that the university period is an important stage for young adults, involving significant academic and psychosocial adjustments. Students with greater Mental Health Literacy (MHL), which is defined as the knowledge, beliefs, and skills individuals have regarding mental health and mental illness, are better able to identify difficulties, seek help, and adopt healthier coping strategies. This study aims to describe the MHL levels of undergraduate health students and identify associated factors related to academic life, mental health and psychological state. Methods: A cross-sectional, self-administered, web-based survey was conducted using a non-probability sampling strategy among undergraduate students in health-related degrees at a Portuguese higher-education institution. Data was collected using a general characterization questionnaire and the following instruments: MHL Questionnaire, Academic Life Satisfaction, Subjective Happiness Scale, Psychological Well-Being Scale (PWBS), and Depression Anxiety Stress Scale. Bivariate and linear regression analyses were employed to identify factors associated with MHL. Results: A total of 306 students (79% female, mean age = 21.6 years; 59% nursing students) participated. The median MHL score was 70 (range: 30–80). The linear regression model explained 17.5% of the variance in MHL. Higher MHL levels were associated with having the course as a first choice, holding a previous degree, reporting taking psychotropic medication use (which may reflect previous mental health service utilization), and higher levels of psychological well-being. Conclusions: This study provides evidence on factors associated with MHL among undergraduate health students, suggesting that higher MHL is associated with greater psychological well-being, highlighting the potential importance of integrating strategies to promote MHL and psychological well-being in health and nursing education. However, these findings should be interpreted with caution due to the single-institution convenience sample, potential self-selection and reporting biases, and cross-sectional design, which limits causal inferences. Full article

Background/Objective: Older patients with end-stage renal disease who receive dialysis often discontinue treatment before the end of their lives. However, the trajectory of family caregiving in this specific context remains under-researched. This study explored the experiences of family members caring for older patients with end-stage kidney disease (ESKD), from the introduction of dialysis to end-of-life care. Methods: This qualitative descriptive study included three family members caring for older patients with end-stage renal disease who were undergoing dialysis in Japan. Data were collected through semi-structured, one-on-one interviews and analyzed using inductive qualitative content analysis within a qualitative descriptive design. Results: The results identified seven categories regarding the family’s experience from dialysis initiation to end-of-life care: Key findings, particularly regarding the terminal phase, included ‘shock of dialysis treatment discontinuation’, ‘last moments shared with the patient’, ‘nostalgic memories of the patient over time, and ‘reflections on end-of-life care for the patient.’ Families described a process wherein the sudden need for proxy decision-making, often without prior discussion, was linked to feelings of regret. Conclusions: The findings describe the continuous experiences of family caregivers in the Japanese context. These exploratory insights suggest that the absence of early Advance Care Planning may contribute to caregiver distress during the withdrawal phase. The results highlight the need for culturally sensitive renal supportive care that fosters communication and understanding of patients’ wishes to mitigate the ethical burdens on families. Full article

Background: The appropriateness of the World Health Organization (WHO) body mass index (BMI) cut-off (≥25 kg/m²) for gestational diabetes mellitus (GDM) screening in Asian populations remains controversial due to the “Asian phenotype,” characterized by higher body fat percentage and visceral adiposity at lower BMI values. This systematic review evaluated the screening and prognostic performance of pre-pregnancy BMI thresholds (≥23, ≥24, ≥25 kg/m²) for predicting GDM in Asian women. Methods: A systematic review and meta-analysis were conducted following the JBI Manual for Evidence Synthesis and PRISMA-DTA guidelines. A comprehensive search was performed in PubMed, Scopus, Embase, CINAHL, Cochrane Library, and Google Scholar from January 2015 to August 2024. Studies reporting screening and prognostic performance of pre-pregnancy BMI for GDM prediction in Asian populations were assessed using the QUADAS-2 tool. Data were synthesized using MetaBayesDTA for univariate random-effects meta-analysis of sensitivity and specificity. A supplementary DerSimonian-Laird random-effects meta-analysis of odds ratios (ORs) was conducted to assess the prognostic association between BMI thresholds and GDM risk. Results: A total of 13 studies were included in the review, comprising a total of 427,159 Asian pregnant women. Most included studies were conducted in East Asian populations, predominantly Chinese, and findings may not generalize to South or Southeast Asian subgroups. For the Asian-standard threshold (≥23 kg/m²; n = 3 studies), pooled sensitivity was 0.47 (95% CrI 0.45–0.49) and specificity was 0.71 (95% CrI 0.56–0.83). For the intermediate threshold (≥24 kg/m²; n = 7 studies), sensitivity was 0.31 (95% CrI 0.25–0.37) and specificity 0.84 (95% CrI 0.80–0.88). For the WHO standard (≥25 kg/m²; n = 3 studies), sensitivity was 0.31 (95% CrI 0.11–0.61) and specificity 0.80 (95% CrI 0.45–0.95). Heterogeneity was extremely high for BMI ≥ 25 kg/m² (I² = 92% for sensitivity), substantially limiting the interpretability of pooled estimates for this threshold. Conclusions: Based on low-certainty evidence from three studies with very high heterogeneity, the WHO BMI criterion (≥25 kg/m²) appears to have clinically insufficient sensitivity for GDM detection in East Asian populations. The Asian-standard threshold (≥23 kg/m²) shows improved prediction (moderate-certainty evidence) but still misses approximately 53% of true positives. Supplementary OR meta-analysis confirms that all three thresholds are significantly associated with GDM risk (pooled ORs 1.80–2.38), though effect sizes are modest. BMI alone is insufficient for GDM screening and should be integrated into multifactorial risk assessment strategies. These findings apply primarily to East Asian populations and may not generalize to South or Southeast Asian subgroups. Full article

Background/Objectives: Despite extensive research on nurses’ knowledge and attitudes toward pain management globally, limited evidence exists regarding the actual implementation of multimodal pain management practices among Vietnamese nurses. This study aimed to (1) assess nurses’ implementation of pharmacological and non-pharmacological postoperative pain management interventions, (2) examine the relationships among knowledge, attitude, and practice (KAP), and (3) identify predictors of competent practice with attention to the relative contributions of formal training versus clinical experience. Methods: A cross-sectional survey was conducted among 230 nurses working in Urology Departments from two tertiary public hospitals in Ho Chi Minh City, Vietnam, between April and June 2024, focusing on postoperative pain management. Pain management knowledge, attitudes, and practices were assessed using validated instruments. Independent samples t-tests compared trained versus untrained nurses. Multiple linear regression identified predictors of practice competency. Effect sizes (Cohen’s d) quantified the magnitude of training effects. Results: Nurses demonstrated moderate-to-good competency, with pharmacological interventions (M = 3.74) implemented more consistently than non-pharmacological interventions (M = 3.48, p < 0.001). Trained nurses significantly outperformed untrained nurses across all domains with large effect sizes (Cohen’s d = 1.34–1.54). A clear hierarchy emerged in non-pharmacological practice: environmental (M = 4.01) > physical (M = 3.69) > cognitive–behavioral (M = 3.27) > spiritual (M = 2.60). Strong KAP correlations were observed (r = 0.70–0.85, p < 0.001). Prior training was the strongest predictor of both pharmacological (β = 1.31, p < 0.001) and non-pharmacological practice (β = 0.58, p < 0.001), while clinical experience showed no significant effect (p > 0.40). Conclusions: This study provides evidence that formal training—not clinical experience—is strongly associated with competent postoperative pain management practice among Vietnamese nurses, with large effect sizes demonstrating practical significance. The strong KAP relationships support targeted educational interventions addressing knowledge gaps to improve practice. These findings have implications for nursing education research in Vietnam and similar healthcare settings. Full article

Traditional palliative care education may limit the development of clinical competencies and attitudes required to alleviate suffering and improve quality of life. Gamification has been proposed as an alternative educational strategy in this field. Background/Objectives: This study aimed to assess the association between gamification-based intervention and palliative care knowledge among nursing students at a public university. Methods: This single-group, pre–post-intervention study was conducted in the Nursing Program of the Universidad Técnica del Norte, Ecuador, including 136 students from the accessible population. Palliative care knowledge was assessed before and after the intervention using the validated Palliative Care Quiz for Nursing (PCQN-SV). Student satisfaction and Moodle usability were assessed using a 10-item Likert-type questionnaire. The gamified educational intervention was delivered online over 60 h. Data were analyzed using descriptive statistics and Wilcoxon signed-rank tests for paired comparisons, and exploratory logistic regression analyses were conducted to evaluate contextual differences across hospitals. Statistical significance was set at α = 0.05. Results: The mean age was 22.9 years (SD = 1.89), and 73.5% were female. Knowledge scores increased significantly after the intervention (Wilcoxon signed-rank test, p < 0.001; r = 0.35). The proportion of students achieving sufficient knowledge (≥13 correct responses) increased from 27.2% (37/136) at baseline to 49.3% (67/136) post-intervention. Contextual analysis indicated variability across clinical training sites, with Lago Agrio showing higher odds of sufficient knowledge (aOR = 3.25; 95% CI [1.26–8.41]; p = 0.015). Conclusions: The gamified intervention was associated with increased palliative care knowledge among nursing students. Heterogeneity across hospitals suggests that contextual factors may influence the magnitude of change. Full article