Nurs. Rep., Volume 15, Issue 12 (December 2025) – 42 articles

Background/Objectives: This review aimed to explore the pathways of nursing and midwifery education in Tanzania and compare them with global perspectives. The goal was to identify similarities, differences, and areas for potential improvement to align with international standards. Methods: A narrative literature review was carried out through databases with published studies in nursing and gray literature. The database search included Medline, PubMed, Google Scholar, EBSCO, PsycINFO, clinical nursing, and gray literature from January 2014 up to December 2024. The search process was carried out by the authors with the following key words: admission, pathway to nursing profession, delivery mode, generative dynamic, and learning models. The search strategy included studies from selected countries in East Africa, Europe, North America, Australia, and Asia. The inclusion criteria were (1) published papers or reviews addressing the review topics; (2) studies published in the English language; (3) gray literature on the reviewed topics; (4) studies originating from Tanzania, East Africa, Europe, Asia, Australia, and North America. The selected countries served as a source for comparison of nursing and midwifery education in Tanzania with the globe. Results: A total of 758 articles were reviewed from the selected databases. Finally, 27 studies and 11 gray literature sources were included. In Tanzania, the overall duration of nursing education from primary education to a bachelor’s degree for diploma graduates is relatively long. Students complete approximately 14 years of schooling from primary education to the completion of a diploma, including three years at the diploma level. To enroll in a degree program, candidates are required to have two years of professional experience, followed by four years of academic training and a mandatory one-year internship. Globally, the duration of educational programs is generally decreasing due to generational shifts and advancements in technology. Conclusions: Whilst nursing and midwifery education is regulated in Tanzania, the current admission criteria and duration of the program do not align with the global standards. Future studies that provide the comparison of curriculums among universities in Tanzania with global standards would provide a deep understanding of the competencies, teaching models, learning environment, duration, and desired learning outcomes for nursing and midwifery education. Full article

Background: Hospital In The Home (HITH), also called Hospital at Home or Virtual Hospital, delivers hospital-level care in patients’ homes to enhance outcomes and reduce hospital bed occupancy. Despite widespread implementation, strategic guidance for managing HITH initiatives remains limited. Methods: Following PRISMA 2020 guidelines, we conducted a systematic review (protocol not registered) searching ScienceDirect and Scopus (inception to December 2023) using the terms “hospital in the home,” “HITH,” “hospital at home,” “virtual care” AND “lesson,” “management,” “governance.” Peer-reviewed studies reporting lessons learned, best practices, or governance strategies for HITH programs with sufficient implementation detail were included; we excluded studies focusing solely on clinical effectiveness without organizational aspects, conference abstracts, and editorials. Two researchers independently screened records, extracted data, and conducted thematic analysis. Quality assessment used the Mixed Methods Appraisal Tool (MMAT). Sixteen studies (12 high-quality, 3 moderate, 1 low) were included. The studies were moderate overall, based on predominantly observational program evaluations and case studies. Results: Forty-two lessons were identified and classified into nine categories: combining care modalities, technology integration, impact on patient outcomes, training and specialized knowledge, care coordination, governance structures, financial sustainability, cross-sector collaboration, and patient selection. These categories fall under four themes: care delivery models; staffing and team dynamics; governance and financial sustainability; and patient selection and safety. Conclusions: This framework provides healthcare executives and program managers with evidence-based guidance for implementing and enhancing HITH programs, addressing a critical gap in governance and management literature. Full article

Background/Objectives: Sex trafficking is a form of modern-day slavery still present in our societies. Health professionals are in a key position to identify and support victims, but adequate training is required. The aim of this study was to analyze the impact of a structured educational intervention on knowledge, perceived professional role, and attitudes toward sex trafficking of women among undergraduate nursing students at the University of Seville, Spain. Methods: A cluster randomized pilot educational trial with a pre-test–post-test control group design and one-year follow-up was conducted. A two-hour educational session addressed key concepts related to sex trafficking, health professionals’ responsibilities, and survivor support. Knowledge and attitudes were assessed at baseline, immediately after the intervention, and at one-year follow-up. Results: 199 students participated. Significant post-intervention improvements were observed in knowledge and attitudes, with sustained impact after one year despite some knowledge decay. Conclusions: This pilot educational intervention appears to improve knowledge and attitudes toward sex trafficking among undergraduate nursing students and may represent a useful strategy for sensitizing and training future health professionals in this area. Full article

Background/Objectives: Low-income compared to high-income women have a higher incidence of and mortality from cervical cancer (CC) due to lower screening rates (under/never-screened). Home-based screening for CC via mailed “self-collection” for human papillomavirus (HPV) testing is an alternative to traditional, provider-collected screening that may be more acceptable to low-income women. Theoretically, adoption of a recent technology, in this case, mailed return of self-collection, is related to the Diffusion of Innovations concepts of advantages and complexity. The purpose of this study was to develop and psychometrically test scales to measure advantages and complexity of self-collection in a low-income, under/never-screened population. Methods: Low-income women (n = 168) were recruited in person from food pantries and online using Facebook in the Midwest U.S. After a baseline survey, women were mailed a self-collection kit. We assessed reliability with item analysis and Cronbach’s α and evaluated validity with exploratory factor analysis and t-tests, using mailed kit return as the independent variable. Results: Two scales were developed: (1) advantages (Cronbach’s α = 0.84), item–total correlation = 0.51 to 0.69, and (2) complexity (Cronbach’s α = 0.82), item–total correlation = 0.45 to 0.64. Exploratory factor analysis supported items factoring on their respective scales, and t-tests supported a relationship between each scale and mailed return of kits. Conclusions: Both the advantages and complexity scales demonstrated reliability and validity among low-income women. Future studies should evaluate these scales in a larger, more diverse population. Nurses could use these scales to assess preferences and difficulties associated with self-collection and aid patients with CC screening decision-making. Full article

Background: Nurses have unique insights into health systems yet remain underrepresented in policy processes. Strengthening political competence is widely regarded as important for evidence-informed nursing leadership. Objectives: To assess self-perceived political competence and policy participation among nurses and nursing students in Croatia. Methods: We conducted a cross-sectional online survey using open, non-probability recruitment. Of 447 individuals who opened the survey link, 440 provided responses and 390 completed all 19 competence items measuring political competence across three domains (attitudes, knowledge/evidence, and skills). Open recruitment precluded calculation of a conventional response rate. A 19-item self-report questionnaire measured political competence across three domains (attitudes, knowledge/evidence and skills); internal consistency was α = 0.91, although the Croatian version has not been fully validated. Data were analyzed using descriptive statistics, binomial tests and ordinal logistic regression on the complete-case sample. Results: Most respondents endorsed nurses’ policy involvement, the importance of scientific evidence and nursing’s holistic perspective. Conclusions: Nurses and nursing students reported strong conceptual support for a policy role but only moderate confidence in influencing policy. These cross-sectional findings highlight a gap between conceptual support and personal confidence that may be addressable through structured educational and institutional support; the impact of such initiatives on policy influence should be examined in future longitudinal or interventional studies. Full article

Climate change poses a major global health threat, with healthcare systems contributing substantially to global greenhouse gas emissions. Health professionals and students play an essential role in advancing sustainable practice, yet many lack the knowledge, skills, and confidence needed to address the environmental impacts of healthcare. This study aims to co-design and evaluate a gamified e-resource that enhances pre-registration health profession students’ knowledge, self-efficacy, and attitudes towards healthcare decarbonisation, while encouraging sustainable behaviour change. A sequential explanatory design will be employed in three phases: (1) a scoping review of the literature; (2) four co-design workshops with students (n = 20) followed by post-workshop focus groups using focused ethnography to explore co-design experiences; and (3) pre- and post-test questionnaires (n = 200) assessing knowledge, attitudes, self-efficacy, behaviours, willingness to act, and usability, followed by focus groups (n = 30) exploring behavioural changes after using the e-resource. The study will generate evidence on how a co-designed, gamified e-resources influence student learning and engagement with healthcare decarbonisation. Findings will inform the integration of sustainability and decarbonisation principles within education and support efforts to equip future health professionals with the competencies required for a low-carbon healthcare system. Full article

Background/Objectives: The integration of Information Technologies has transformed interactions between healthcare professionals and the families of hospitalized patients, enabling more comprehensive, transparent, and patient-centered care. Artificial Intelligence is emerging as a transformative tool to further enhance these interactions; however, its implementation faces challenges associated with access to and availability of basic technological infrastructure. Methods: This cross-sectional pilot study, conducted at the Tamaulipas Children’s Hospital, Mexico, included 51 healthcare professionals from diverse specialties. It examined the use of digital technologies and perceptions of information systems aimed at optimizing communication with families. Results: Findings indicated that 58.8% reported consistent use of digital devices, whereas only 41.2% had regular internet access. Between 60.0% and 67.0% consistently provided information regarding patients’ health status, treatments, and medical procedures. With respect to a digital system, 37.3% considered its implementation necessary and 39.2% perceived potential benefits, although functions such as multimedia sharing and automated notifications were regarded with caution. The questionnaire demonstrated high reliability (α = 0.835) and acceptable construct validity (KMO = 0.705; Bartlett’s test p < 0.001). Conclusions: Preliminary results suggest that the integration of AI-based digital systems in hospital settings remains conditional. They also highlight the need to ensure equitable access to technological infrastructure as a prerequisite for achieving sustainable adoption. Full article

Background/Objectives: Clinical instruction and mentorship are essential components of nursing education and early professional development. In Greece, while nursing curricula align with EU directives mandating both theoretical and clinical training, significant gaps persist in the quality, coordination, and legislative support of mentorship. This work aims to (i) synthesise evidence on clinical instruction and mentorship in Greece and draw on selected European examples to provide contextual insight, and (ii) integrate national stakeholder perspectives to generate actionable recommendations for a Greek clinical mentorship framework. Methods: A narrative literature review was conducted, identifying 19 eligible articles examining mentorship, clinical instruction and preceptorship in European and Greek contexts. In addition, a national stakeholder focus group with 25 participants, including representatives from academia, healthcare institutions, regulatory bodies, and nursing associations, was held in Athens in 2024. Data from both sources were thematically analysed and integrated to identify gaps, best practices, and context-specific recommendations. Results: Findings revealed inconsistent collaboration between universities and clinical institutions, limited training and recognition for clinical instructors, and the absence of a unified national framework. Stakeholders highlighted structural barriers to clinical mentoring such as understaffing and lack of policy support and expressed strong interest in a mentorship reform. Comparative analysis with European models demonstrated feasible pathways for Greece, including structured training, certification, and non-financial incentives. During the national stakeholder focus group, a dual-pathway mentorship system tailored for nursing students and newly hired nurses was most recommended to ensure both continuity and quality in professional development of nurses. Conclusions: Despite alignment with EU directives, Greece lacks an integrated national mentorship framework that ensures consistent clinical learning and supports workforce development. Two priority policy actions emerge from this work: (1) establishing a legally supported national certification and training system for clinical mentorship, and (2) educational structures in the clinical setting to improve educational quality, workforce retention and patient care outcomes. Full article

Background/Objectives: Structural empowerment involves access to opportunities, information, support, and resources within the work environment. These elements are crucial as they foster nurses’ professional growth and autonomy. Given their significance, understanding hospital nurses’ perceptions of structural empowerment is important. Therefore, the aim of this study is to explore hospital nurses’ perceptions of their levels of structural empowerment. Methods: This cross-sectional study included 684 nurses from a Portuguese hospital, conducted between November 2024 and January 2025. The questionnaire collected demographic data and employed the Conditions of Work Effectiveness Questionnaire II. Results: The mean total score for structural empowerment was 18.74 (SD = 3.46), with significant differences found between nurses and specialist nurses, for those with the specialist title (p = 0.0477) and within the professional category (p = 0.0058), as well as between nurses working day shifts and those working day and night shifts (p < 0.0001). Additional significant differences were observed between nurses from the Medicine department (median [Q1–Q3]: 19.25 [17.00–21.50]) and those from the Surgery department (18.17 [16.00–20.25], p = 0.0104), as well as between Generation Z nurses (19.58 [17.33–21.83]) and Generation Y nurses (18.29 [16.25–20.33], p = 0.0018). Conclusions: These results underscore the importance of consistently promoting structural empowerment across the nursing staff, addressing disparities between groups, and improving both professional development and quality of patient care. Full article

Background/Objectives: The institution of the nursing assistant (NA) profile in Italy, established by the Decree 28 February 2025 responds to the chronic shortage of healthcare personnel, especially in nursing. This figure, non-healthcare but trained to perform basic healthcare tasks, aims to support nurses and ensure continuity of care, especially in community and long-term care settings, through further nursing activities delegation. The model aligns with international practices, emphasizing delegation within multiprofessional teams, based on formalized protocols and continuous on-site training, within standardized, low-discretion contexts. The delegation of health activities, however, presents legal and medico-legal challenges regarding scope of practice and supervision. Methods: The aim of this paper is critically discussing delegation of health activities to non-healthcare providers and the related issues of liability in team-based delivery of care, considering the specific regulatory setting of health providers in Italy. Results: Critical activities such as nutrition and hydration, in particular artificially, and drug administration highlight the limits of delegation and the ongoing need for professional nurse oversight. In pre-hospital emergency care, standardized, protocol-based systems and simulation-based training successfully integrate non-healthcare personnel within the health team. Conversely, chronic and long-term care remain fragmented, lacking organizational maturity, regular supervision, and uniform regulation. Conclusions: The decree represents a step toward structured team-based care, but its success depends on robust governance, protocol clarity, organizational guidelines, and sustained practice-based education to prevent unsafe delegation and unauthorized practice. Full article

In response to persistent gaps in pain management competencies among nurses in Saudi Arabian teaching hospitals and similar healthcare settings globally, this manuscript presents a developed and validated action plan designed to support the effective transfer of pain management competencies into clinical practice. The action plan was developed to address the critical need for structured, practical strategies that enhance nurses’ ability to apply pain management knowledge in diverse interdisciplinary environments. The action plan was validated through a rigorous three-round e-Delphi technique involving 12 expert panel members, achieving a 75% consensus on its content and structure. The final validated plan includes clear action statements, implementation methods, designated responsibilities, and defined timeframes. The core action statements focus on the following: (i) motivating nurses to pursue further study; (ii) equipping nursing teams with appropriate pain management tools; (iii) developing content-specific, practice-oriented short training programs; (iv) tailoring training to accommodate different learning styles; (v) using diverse teaching methods; (vi) creating strategies to encourage participation in training; and (vii) promoting the application of acquired knowledge in clinical settings. Adoption and implementation of this action plan by nursing leadership are anticipated to significantly enhance the transfer of pain management competencies, ultimately improving patient outcomes. The plan is adaptable for use in similar healthcare settings worldwide, offering a replicable model for strengthening nursing practice through targeted competency development. Full article

Background: Nursing students face emotional and psychological challenges stemming from early clinical exposure, intense academic pressure, and persistent social stigmas. These stressors can contribute to mental health deterioration and increase the risk of suicidal thoughts and behavior. Objective: To evaluate the psychosocial context and identify risk and protective factors contributing to suicidal behavior in undergraduate nursing students. Methods: This cross-sectional study included 433 undergraduate nursing students and utilized validated psychological instruments to assess suicidal behavior, emotional distress, impulsivity, anhedonia, mental health, and perceived social support. Data were analyzed using descriptive statistics, bivariate tests, exploratory factor analysis, and multivariate modeling to identify key predictors of suicidal behavior. Network visualization was used to integrate significant point-biserial correlations with factor loadings. Results: Among 433 nursing students (77.8% women, 93.8% cisgender, mean age 19), 15.2% showed clinically significant suicidal risk. Suicidal behavior was more frequent among women and students living away from home (p < 0.05). Higher levels of impulsivity, ADHD symptoms, and especially moderate-to-severe hopelessness (p < 0.001) were strongly associated. Hazardous alcohol use was also a significant risk factor (p < 0.01), while strong material and emotional support showed a protective effect (p < 0.05). Two psychological dimensions, emotional distress/impulsivity and hopelessness/low support, explained most of the variance. Conclusions: 1 in 7 nursing students show clinically relevant suicidal risk, particularly those with heightened hopelessness, emotional dysregulation or hazardous alcohol use. Protective social support plays a key mitigating role. These results underline the urgent need for tailored mental health interventions that specifically address emotional regulation and hopelessness, while reinforcing social support systems within nursing education contexts. Full article

Background/Objectives: Community paramedicine programs have existed since the early 2000s, and while resource optimization remains a predominant driver, innovation in recent years demonstrates that when community paramedicine is integrated into healthcare, it is well-positioned to support the needs of structurally marginalized communities by focusing services for those facing barriers to accessing equitable care. A recent scoping review described the evolving ways community paramedicine models are addressing health and social needs within communities around the world. We aimed to identify and explore existing community needs assessment tools in Canada to guide the initial development of a needs assessment tool for community paramedicine. Methods: We conducted a document analysis of existing community needs assessment resources to identify current tools or processes used to identify community needs, as well as determine gaps to address and support. Documents were collected for review via a targeted literature search of both published and gray sources, and direct document requests of community paramedicine service providers to review guides informing current service planning in Canada. We presented a draft of the tool to participants at a community paramedicine conference for their review and feedback, and we incorporated this feedback into the final version. Results: We reviewed 38 documents to identify and synthesize key elements within community health and social needs assessment tools and frameworks. Findings informed an interim Community Paramedicine Needs Assessment Tool (CPNAT) that the team presented to 112 community paramedicine experts and partners. We received 33 group responses of detailed feedback that we used to further refine and finalize the tool. Conclusions: The CPNAT can support enhanced health equity by guiding community paramedicine programs to better align services, policies, and funding with the health and social care needs of communities. Full article

Background/Objectives: Evidence-Based Practice (EBP) positively impacts health safety and quality while also empowering nursing as a discipline. A useful strategy for promoting EBP is to build learning paths adapted to the individuality of nurses. These elements establish the framework for effective learning, determining the availability of specific content at certain times and influencing the design of learning objects to ensure optimal efficacy in the teaching-learning process. It is essential to identify effective strategies in evidence-based nursing education to advance EBP and thereby enhance the quality and safety of nursing care. This review aims to summarize the evidence on the effectiveness of learning paths in the acquisition of EBP competencies by nurses. Methods: A systematic review of the literature will be carried out in accordance with the Joanna Briggs Institute (JBI) methodology for systematic reviews of effectiveness. The results of the review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocols (PRISMA-P). The protocol is registered in the PROSPERO database (CRD4202453155). The search will be performed using the EBSCOhost search engine in the following databases: CINAHL Plus, MedicLatina, MEDLINE, Psychology and Behavioral Sciences Collection, Academic Search Complete, eBook Collection, and Education Resources Information Center. The inclusion of studies, data extraction, and analysis will be carried out by two reviewers independently. Disagreements will be resolved by a third reviewer. All studies involving nurses, learning paths, EBP competencies, regardless of geographical area and context, with no time limit or language constraints, will be included. Results: Not applicable; this is a protocol. Findings will be synthesized as specified in the Methods. Conclusions: This review will provide a better understanding of the effectiveness of a learning path in the acquisition of EBP competencies by nurses. It will also assist in the identification of knowledge gaps in the literature and potential areas for future research and development. Full article

Background: Patient participation during Nursing Bedside Handover (NBH) is a dyadic interaction between the patient and nurses that allows the patient to participate, either passively or actively, in communication activities and nursing care. Objective: This state-of-the-art (SotA) review aimed to synthesize current knowledge on patient participation during NBH and identify future directions for bedside handover research. Methods: The literature search was conducted through PubMed, CINAHL Complete, and Scopus, and was supplemented by citation searching. Search was limited to peer-reviewed scientific articles using any empirical study design that addressed patient participation during NBH published in English by August 2025. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool. Results: A total of 50 primary research articles were included and examined using the method of constant comparisons. The synthesized data were categorized into three main themes: (a) Domain of distinctive nature and attributes of patient participation during NBH; (b) domain of nurses’ practices and influencing factors of patient participation during NBH; and (c) domain of strategies and impacts of increasing patient participation during NBH. Within each domain, research trends were identified concerning patient participation in NBH. Future research directions are presented within each domain. Conclusions: The findings of this review may provide new insights into developing complex interventions aimed at increasing patient participation in NBH by nurses, namely with the use of co-design strategies, as well as the adoption of transfer protocols that incorporate informational and interactional components and assessment tools to measure patient participation in NBH. Full article

Background: The transition from student to registered nurse is a vulnerable period characterised by emotional strain, role ambiguity, and transition shock. Although Graduate Nurse Transition Programs (GNTPs) aim to strengthen early practice readiness, few evaluations use longitudinal, theory-informed approaches or validated tools. Aim: To examine the professional role development of new graduate nurses (NGNs) across three transition stages within a major Australian health service. Design and Methods: A longitudinal quantitative study guided by Duchscher’s Stages of Transition Theory and the Transition Shock Model. A customised 75-item questionnaire—adapted from the Professional Role Transition Risk Assessment Instrument and the Professional and Graduate Capability Framework—was administered at three transition points (March 2020–March 2021). Four domains were assessed: Responsibilities, Role Orientation, Relationships, and Knowledge and Confidence. Descriptive statistics, Principal Component Analysis (PCA), chi-square tests, and multinomial logistic regression identified developmental patterns and predictors of transition stage. Results: PCA supported a four-factor structure consistent with the theoretical domains, explaining 62% of variance. Significant stage-based improvements were found in clinical decision-making (RS6, p = 0.005), managing pressure (RS11, p = 0.003), leadership perception (RO5, p = 0.001), and emotional regulation (RL20, p < 0.001). Regression analysis identified role confusion (RS7, χ² = 18.112, p = 0.001), leadership potential (RL1, χ² = 25.590, p < 0.001), workplace support (RL16, χ² = 12.760, p = 0.013), and critical thinking confidence (KN13, χ² = 10.858, p = 0.028) as strong predictors of transition stage. By Stage 3, most NGNs demonstrated increased autonomy, confidence, and professional integration. A coordinator-to-graduate ratio of 1:12 facilitated personalised mentorship. Conclusions: Findings provide robust evidence for theoretically grounded GNTPs. Tailored interventions—such as early mentorship, mid-stage stress support, and late-stage leadership development—can enhance role clarity, confidence, and workforce sustainability. Full article

Background/Objectives: Health literacy (HL) plays a fundamental role in maternal and neonatal outcomes by influencing women’s ability to access, understand, and apply health information during pregnancy. However, evidence regarding the determinants of HL among pregnant women remains limited, particularly within the Spanish context. This study aimed to assess HL levels among pregnant women and to examine their association with personal, socioeconomic, and health-related factors. Methods: A cross-sectional study was conducted between January 2023 and February 2024 across nine primary care centres within the Vigo Health Area (Spain), including 182 pregnant women receiving prenatal care. HL was measured using the 16-item European Health Literacy Survey Questionnaire (HLS-EU-Q16). Sociodemographic, obstetric, and health-related variables were collected through structured interviews. Descriptive and inferential analyses were performed to explore associations between HL and the selected variables. Results: Limited HL was observed in 35.7% of participants. A significant association was found between HL and family income (p = 0.037), with limited HL being more frequent among women with a monthly family income below €2000. No associations were identified with other sociodemographic or health-related variables. Thirty-nine per cent of participants visited hospital emergency services on two or more occasions, mostly without admission. The main source of information was healthcare professionals, although Internet use was also relevant. Conclusions: The prevalence of limited HL was lower than that reported in other national studies, although inequalities related to family income persisted. These findings highlight the need to incorporate systematic, HL-tailored strategies into prenatal care, based on prior HL assessment, to promote informed decision-making and improve maternal and neonatal outcomes. Full article

Background: Humanitarian surgical missions play a critical role in addressing health disparities, particularly in low-resource settings where conditions such as cleft lip and palate (CL/P) are prevalent. The success of these missions relies heavily on the commitment of volunteers, including healthcare professionals and logistical personnel. While their contributions are widely acknowledged, the psychological and emotional impact of participating in such missions remains underexplored. Objective: This study protocol aims to explore the lived experience of volunteers involved in humanitarian surgical missions. Materials and Methods: A qualitative study, using Interpretative Phenomenological Analysis (IPA), will be conducted. Semi-structured interviews will be carried out with volunteers who have participated in at least one humanitarian surgical mission. Interviews will be audio-recorded, transcribed verbatim, and analyzed to identify emerging themes. Data collection will continue until saturation is reached. The reporting of this study will follow the COREQ guidelines. Expected Results: This study is expected to provide a deeper understanding of the emotional and professional experiences of volunteers in surgical missions. Expected results include identifying key themes related to motivation and preparation, on-site engagement, field experience, interpersonal relationships and group dynamics, and personal reflections. These results will inform strategies to enhance the effectiveness of missions, improve volunteer support, and ensure the sustainability of humanitarian interventions. Additionally, these findings will contribute to the broader field of international health volunteering and support future program development. Conclusions: This protocol outlines a rigorous qualitative approach to investigating the lived experience of volunteers in humanitarian surgical missions. The anticipated findings are expected to inform targeted training, psychological support, and organizational strategies, ultimately improving the effectiveness and sustainability of future missions and the well-being of volunteers. Full article

Background/Objectives: Nurses and nursing technicians are essential providers of patient care but remain highly vulnerable due to the demands of their profession, which can profoundly affect their professional quality of life. Understanding the risk and protective factors underlying different aspects of professional quality of life is crucial for fostering healthcare professionals’ overall well-being and ensuring high-quality care for patients. The aim of this study was to explore the relationships between professional quality of life, work-related factors, PTSD symptomatology and individual resources, including resilience and coping strategies. Methods: This cross-sectional study included 119 nurses from various nursing departments. A questionnaire comprising sociodemographic and work-related variables and four validated instruments, Professional Quality of Life Scale-5 (ProQOL-5), PTSD Checklist for DSM-5 (PCL-5), Brief-COPE and Brief Resilience Scale, was used for data collection. Results: Findings revealed moderate to high compassion satisfaction among nurses and technicians, as well as low to moderate burnout and moderate levels of secondary traumatic stress. Compassion satisfaction was positively associated with problem-focused and emotion-focused coping, whereas higher levels of compassion fatigue (burnout and secondary traumatic stress) were associated with avoidant coping, greater PTSD symptom severity, and lower resilience. Resilience, problem-focused coping, and PTSD symptom severity were identified as significant predictors of professional quality of life. Conclusions: To support nurses’ and technicians’ well-being, healthcare organizations should encourage open conversations about the emotional demands of patient care and provide interventions that promote effective coping and address PTSD symptoms, ultimately helping to reduce compassion fatigue and enhance compassion satisfaction. Full article

Background/Objectives: Eating behavior disorders (EBDs) are a public health concern among undergraduate students. Evidence suggests that certain health-related academic environments may be associated with heightened psychological vulnerability. Hence, we aimed to evaluate the association between nursing education and the risk of EBDs and to assess whether self-esteem and anxiety mediate this relationship. Methods: A cross-sectional analytical study was conducted between July and August 2023 among 433 undergraduate students from two public universities in Hidalgo, Mexico. The sample included 209 nursing students and 224 peers from non-health-related programs. Self-esteem, anxiety, and EBD risk were assessed using the Rosenberg Self-Esteem Scale, Hamilton Anxiety Rating Scale, and Eating Attitudes Test-26, respectively. Logistic regression and counterfactual mediation analyses were performed, adjusting for age, sex, family income, and year of study. Results: Nursing students showed higher odds of low self-esteem (aOR = 1.64; 95% CI: 1.06–2.53), anxiety (aOR = 2.06; 95% CI: 1.25–3.37), and EBDs risk (aOR = 2.37; 95% CI: 1.37–4.09) compared with non-health peers. Mediation analyses revealed significant indirect effects through self-esteem (aOR = 1.20; 95% CI: 1.03–1.38) and anxiety (aOR = 1.14; 95% CI: 1.01–1.29). Conclusions: Nursing education was independently associated with a higher risk of EBDs, with statistical mediation analyses indicating that differences in self-esteem and anxiety may help characterize this association. Self-esteem exerted a slightly stronger indirect effect, suggesting that negative self-evaluation may represent a more proximal psychological process rather than a causal determinant. Full article

Background/Aim: The quality of care provided to patients was closely related to the nursing staff’s well-being and their experience within the organization. This study aimed to evaluate the psychometric properties of the short form of the Nurses’ Organizational Health Questionnaire (QISO-SF), with a focus on its relevance for assessing nurses’ organizational well-being in healthcare environments. The study examined the instrument’s structural validity and internal consistency. Methods: A secondary analysis was conducted using data from three cross-sectional studies, including 1279 nurses providing direct patient care across various Italian healthcare settings. Dimensionality of the QISO-SF was tested via confirmatory factor analysis (CFA), and reliability was assessed using ordinal omega coefficients (ω). Results: The QISO-SF comprises 48 items across 11 dimensions, grouped into 5 scales: Comfort, Organizational Context and Relational Processes, Workload, Positive and Negative Indicators, and Psychophysical Distress. The instrument demonstrated good structural validity (RMSEA = 0.048–0.094; CFI = 0.967–0.994) and satisfactory reliability (ω = 0.644–0.857). By maintaining the theoretical framework of the original questionnaire while reducing completion time, the short form is suitable for evaluating nurses’ work-related quality of life and organizational well-being. Conclusions: The QISO-SF is a concise, reliable, and valid tool to assess work-related quality of life and Organizational health in nursing professionals. Its use can support interventions aimed at promoting well-being in healthcare settings. Full article

Background: Patients with Rheumatic and Musculoskeletal Diseases (RMDs) who are treated with Disease-Modifying Anti-Rheumatic Drugs (DMARDs) face an increased risk of infections. Therapeutic education is often considered a valuable strategy to support preventive behaviors, but its actual impact remains uncertain. Objectives: This scoping review aims to examine how therapeutic education contributes to infection prevention in patients with RMDs receiving DMARDs, with attention to its potential benefits, limitations, and relevance in clinical practice. Methods: Following the PRISMA-ScR framework, we searched PubMed, CINAHL, EMBASE, and Web of Science for primary studies published between January 1990 and December 2024 in English or Italian language. Eligible studies involved adult patients with rheumatic diseases treated with DMARDs who had received some form of therapeutic education. Results: Among 1591 records, only 4 studies met the inclusion criteria. These studies emphasized the value of promoting preventive behaviors to minimize treatment-related infections. Therapeutic education was associated with increased patient awareness and adherence, especially when supported by multidisciplinary healthcare teams. However, several barriers—such as limited health literacy and socioeconomic challenges—affected access and effectiveness. Discussion and Conclusions: While existing studies support the potential of therapeutic education and patient education in general, the small number of relevant studies and the variation in approaches limit strong conclusions on the impact of patient education on reducing or preventing risk infection in the field of rheumatology in DMARD-treated patients. Moreover, several papers pointed out how digital tools and telemedicine are promising ways to expand access and improve adherence, particularly for underserved populations. Thus, further research should explore standardized, inclusive and interdisciplinary strategies—potentially incorporating digital tools—to improve prevention and ensure equitable access to educational interventions. Full article

Background/Objectives: Emergency healthcare professionals are continually exposed to high clinical and organizational demands that compromise their mental, physical, and occupational health. This systematic review and meta-analysis examined the prevalence and interrelations of biopsychosocial and work-related health outcomes among emergency personnel, providing an integrated synthesis of recent empirical evidence. Methods: A systematic search of PubMed, Scopus, Web of Science, and CINAHL identified 6214 records, of which 50 studies met inclusion criteria and were analyzed (total n = 278,000 emergency professionals). Eligible studies (2020–2025) evaluated biopsychosocial outcomes (burnout, depression, stress, resilience, sleep quality) and occupational indicators (workplace violence, job satisfaction, effort-reward imbalance, engagement, turnover intention). Meta-analyses were conducted using random-effects models (DerSimonian-Laird method), producing pooled prevalence estimates for each outcome based on the number of studies that reported the corresponding variable. Risk of bias was assessed using the Joanna Briggs Institute tools, with most studies rated as moderate-to-high quality. Results: Pooled estimates showed fair self-perceived health in 44.0%, severe burnout in 10.7%, depressive symptoms in 35.1%, moderate-to-severe stress in 74.6%, and poor sleep quality in 40.1% of staff. Workplace violence affected 76.9% of professionals. Job satisfaction averaged 68.1%, turnover intention 62.1%, and effort-reward imbalance 61.9%. Resilience was predominantly moderate (33.9%). Considerable heterogeneity was observed; however, patterns were consistent across regions and professional roles. Conclusions: Emergency healthcare personnel face substantial biopsychosocial strain and occupational risks, driven by persistent structural pressures. Health systems should implement integrated organizational strategies to reduce violence, enhance psychological support, ensure safe staffing, and protect rest and recovery. Improving staff well-being is essential for maintaining a resilient and effective emergency care workforce. Full article

Background: Clinical Learning Environments (CLEs) are essential to nursing education as a platform for students to develop professional identity; consolidate knowledge with clinical practice; and to gain cognitive, communication, and psychomotor skills. Experience in CLEs significantly impacts nursing students’ satisfaction with education and graduate career preferences. The Clinical Learning Environment, Supervision and Nurse Teacher scale (CLES+T) is widely used to measure the quality of professional experience placements (PEPs), but it has limited evidence of psychometric performance in rural and regional Australian contexts. Aim: To assess the psychometric properties of the CLES+T scale in the Australian context of rural and regional undergraduate nursing PEPs. Methods: A cross-sectional observational study of a convenience sample of 165 undergraduate nursing students from regional Victoria, Australia, who undertook PEPs between January and June 2020. Participants completed the CLES+T scale post-PEP. Statistical analyses included a test of survey tool reliability using Cronbach’s alpha and exploratory factor analysis to investigate instrument dimensionality and validity. Results: The CLES+T scale displayed adequate validity and reliability levels and demonstrated internal consistency similar to previous studies. The most important factor in the CLE was revealed as “pedagogy atmosphere and the content of supervisory relationship” followed by “role of the nurse educator”. Conclusions: The CLES+T shows adequate psychometric properties as a valid tool for use with undergraduate nursing students undertaking PEPs in Australian regional, rural, and remote settings. Full article

Background: Comprehensive care is increasingly being recognised as a critical component of healthcare, with several countries endorsing it as a national standard. This study aims to explore care professionals’ perspectives on the barriers, enablers, and impacts of implementing the Comprehensive Care Standard (CCS) in acute care hospitals across Australia. Methods: This is a qualitative descriptive study. Participants included 28 care professionals (20 nurses, 2 doctors, and 6 allied health professionals) recruited from a broad range of Australian acute care hospitals. Data were collected using semi-structured interviews from March to August 2023. The interviews were audio-recorded, transcribed and thematically analysed. Data collection and analysis were guided by the Consolidated Framework for Implementation Research (CFIR), and implementation strategies were mapped to the Expert Recommendations for Implementing Change (ERIC). Results: CFIR-informed analysis identified 12 barriers and 13 enablers to CCS implementation, most prominently within the Inner Setting and Implementation Process domains. Sixteen implementation strategies were also mapped using the CFIR-ERIC Mapping Tool. The perceived impacts of the CCS implementation were multifaceted. While CCS implementation brought about changes to hospitals and improvements in patient care, it also resulted in increased workload and fatigue among staff. Conclusions: Enhancing CCS implementation will involve addressing the barriers and building on the enablers identified in this study. Supporting more effective implementation may help maximise the benefits of the CCS for patient care while also mitigating the increased workload and fatigue reported by staff. These findings highlight the importance of approaches that balance quality improvements with staff wellbeing. Full article

Background: Mental health problems are increasingly common among children and adolescents, making schools a key setting for health promotion. Nurses can play a central role in prevention and support, but in Chile, the role of the school nurse has not yet been formally established. Understanding nursing students’ experiences in school-based mental health promotion can inform curriculum development and strengthen professional identity. Methods: A qualitative study with a phenomenological approach was conducted with third-year nursing students enrolled in a mental health course (N = 64). Data was collected through six individual interviews and one focus group, transcribed verbatim and analyzed using ATLAS.ti 25.0.1^®. To ensure rigor, the study was guided by the Consolidated Criteria for Reporting Qualitative Research (COREQ), and trustworthiness was ensured following Lincoln and Guba’s criteria. Results: Five main categories emerged: nursing’s role in mental health promotion; perceptions of health promotion as prevention; use of the educational process, with difficulties in formulating objectives; perceived self-efficacy, marked by initial uncertainty in working with children; and experiences in implementing projects, including reflections on the professional role, mixed feelings, facilitators, barriers, and coping strategies. Facilitators included faculty support, teacher collaboration, and group cohesion, while barriers were related to limited experience, challenges in managing children, and external conditions such as noise and unsuitable classroom conditions. Conclusions: School-based practicums in mental health promotion are valuable opportunities to integrate theory and practice, strengthen professional identity, and develop communication. Strengthening undergraduate curricula with systematic training in these areas is essential for preparing nurses for their role in school and community health. Integrating these experiences into clinical and assistive practice can enhance early detection, interprofessional collaboration, and the promotion of healthier school environments. Full article

Background: The implementation of shared governance within the nursing practice results in heightened satisfaction among nurses and enhances the quality of care provided. Shared governance fosters collaborative and proactive relationships among nurses and healthcare providers, while also cultivating a sense of confidence among nurses. However, evidence suggests that a lack of awareness, reliance on traditional governance, and inadequate shared governance structures among nurses continue to exist at the unit-based council (UBC) level, including those in the Kingdom of Saudi Arabia (KSA). Purpose: The present study aimed to assess the extent of clinical nurses’ perceptions concerning shared governance at the UBC level, and to examine the variations and relationships in their perceptions based on demographic and work-related characteristics. It further explored the demographic and work-related factors that affect the overall perceptions of shared governance among clinical nurses. Methods: This quantitative study utilized a cross-sectional design and was carried out in three governmental hospitals in the KSA. The sample comprised 669 nurses, who were selected using a convenience sampling method. The Index of Professional Nursing Governance (IPNG) tool was utilized for data collection conducted between February 2025 and April 2025. Descriptive statistics alongside the t-test and analysis of variance (ANOVA), Pearson-r correlation coefficient, and multiple linear regression were utilized for data analysis. Significant findings were drawn when p ≤ 0.05. Results: The average perception of shared governance among clinical nurses at the UBC level was 180.42 out of 430, suggesting that decision-making occurs collaboratively between nurses and management. Significant differences in the average level of clinical nurses’ perceptions of shared governance were noted in relation to their educational qualifications (F = 5.015, p = 0.001) and nursing units (F = 4.157, p = 0.010). The hospital in which clinical nurses were employed (r = 0.098, p = 0.037) and nursing units (r = 0.087, p = 0.020) exhibited significant correlations with their overall shared professional governance. Furthermore, the hospital where clinical nurses were employed (β = 0.406, p = 0.001, 95% confidence interval [CI] = 0.166, 0.646) and nursing units (β = 0.326, p = 0.038, 95% CI = 0.018, 0.314) served as predictors of their overall professional shared governance. Conclusions: Clinical nurses in this study showed an initial or relatively low level of shared governance at the UBC level. The overall finding highlights a critical need for nursing managers and leaders to enhance the level of professional shared governance among clinical nurses, which may result in improved nurse retention and overall quality of nursing care. It is crucial to consider clinical nurses’ educational qualifications and working environment at the UBC level when aiming to enhance their level of professional shared governance. Full article

Background/Objectives: Obstetric violence (OV) is a violation of women’s human rights during reproductive processes. Despite being the subject of debate among healthcare professionals, increasingly recognized, and legislated against in some countries, OV continues to be reproduced and normalized during training. The objective of this study was to determine the perception of OV among health sciences students and gynaecology and obstetrics residents. Methods: A cross-sectional observational study was conducted with 304 health sciences students and gynaecology and obstetrics residents in Spain. An online questionnaire was distributed that gathered information on sociodemographic variables and clinical experience and included the validated PercOV-S instrument. Descriptive and bivariate analyses were performed to explore associations between variables. Results: The overall perception of OV was moderately high (mean 3.93/5), with higher scores for visible or protocolized forms (4.27/5) than for invisible or subtle forms (2.87/5). Being a woman, being a midwifery resident, or having had personal experiences with pregnancy or childbirth increased sensitivity to OV. Clinical exposure in obstetrics and gynaecology services increased both awareness and the likelihood of witnessing OV. Twenty-eight percent of students reported having observed OV, and twenty percent reported emotional distress, even considering dropping out. Conclusions: Despite the recognition of OV, repeated exposure during training can promote its normalization. The results of this study highlight the need for safe, reflective training environments that mainstream feminist perspectives, sexual rights, and the detection of subtle forms of OV. Full article

Background: Nurses need strong English language skills to access knowledge and promote evidence-based practice. Podcast production is a promising pedagogical strategy to improve language skills. However, the effects of podcast production on nursing students’ perceived English reading proficiency and the most effective production instructional approaches remain unreported. Aim: To examine the impacts of podcast production on undergraduate nursing students’ perceptions of English reading skills and compare the effectiveness of two podcast production teaching methods. Design: A quasi-experimental study. Methods: 78 third-year nursing students in Northern Thailand were divided into an experimental group (n = 39) and a control group (n = 39). The experimental group received specific guidelines for podcast production, while the control group used a non-guided method. Outcomes included students’ perceptions of their English reading skills and the experimental group’s attitudes toward podcast production guidelines. Results: Pre-test scores for perceived English reading skills were similar between groups (t = −1.029, p = 0.307). ANCOVA revealed that after controlling for pre-test scores, the control group reported significantly higher adjusted post-test scores than the experimental group (F = 5.001, p = 0.028). Students in the experimental group expressed positive attitudes toward the podcast production guidelines. Conclusions: Both podcast production approaches were effective; however, the less-guided approach showed greater improvement in students’ perceptions of their English reading skills. This approach may encourage student autonomy, creativity and deeper engagement. Podcast production emerges as a valuable student-centred learning strategy to improve perceptions of language skills, but finding a balance between support and independence during instruction seems important to maximise its potential benefits. Full article