Nurs. Rep., Volume 15, Issue 2 (February 2025) – 45 articles

Clostridioides difficile (C. difficile), a gram-positive, spore-forming bacillus, has emerged as a leading cause of healthcare-associated infections, significantly contributing to infectious diarrhea and increasing healthcare costs. This descriptive, cross-sectional study was conducted among Saudi Arabian nursing staff from July to December 2023 to assess their knowledge and practices related to the diagnosis and management of C. difficile infection (CDI). Data were collected using a modified questionnaire. Overall, 358 nurses were surveyed, and 66% reported knowledge of C. difficile procedures. However, only 30.4% of the respondents correctly classified C. difficile as an anaerobic bacillus, while 42.2% were aware of the organism’s common occurrence in healthy adult volunteers. Additionally, 55.6% of respondents were aware of risk factors and 48.9% could name typical medicines that might cause illness. Only 24.0% acknowledged the cytotoxin test as the gold standard for detection, 26.8% identified hand washing with water and soap as an effective method to prevent the transmission of CDI, and 36.3% identified oral metronidazole as the first-line treatment for CDI. In summary, this study revealed a significant lack of awareness among nurses in Saudi Arabia regarding various aspects of CDI, emphasizing the need for improved education and training to address the knowledge gaps and quality of patient care. Full article

Background: The Caring Massage^® (CM) consists of nurse–patient physical and mental contact. It promotes empathetic presence and emotional closeness and strengthens trust and safety in the nurse–patient relationship. However, previous studies have underexplored and under-evaluated its effectiveness on different body areas. This study aimed to identify the body areas to be treated and assess CM’s influence on the nurses performing it and patients receiving it. Method: A Delphi study was conducted to gather expert opinions on Caring Massage^®. A preliminary list of body areas and variables influenced by CM was developed from a literature review and submitted to panelists to identify outcomes, achieving an acceptable content validity rate. Patient and nurse variables as influenced by CM were categorized into “Bio-Physiological Outcomes” (BPOs), “Psychological Outcomes” (POs), and “Sociological Outcomes” (SOs). Two Delphi rounds were conducted between July and October 2024. Results: A total of 86 panelists were recruited, who identified 58 variables (7 body areas, 29 patient variables, and 22 nurse variables). Feet, legs, back, hands, shoulders, and arms were identified as key CM treatment areas. Patient outcomes identified as highly influenced by receiving CM were quality of sleep (BPO), emotional well-being (PO), and nurse–patient relationship (SO). Nurse outcomes highly influenced by performing CM were physical well-being (BPO), body respect (PO), and consideration of the patient as a person (SO). Conclusion: Caring Massage^® influences multiple aspects concerning both the patients receiving it and nurses performing it. This study addressed the heterogeneity observed in the literature, providing a foundation for future studies and encouraging further investigations. Full article

Background/Objectives: South Korea has expanded nursing transfer programs to address its ongoing nursing shortage, but research on transfer students’ experiences remains scarce, and studies on academic persistence and attrition remain limited. This study aimed to explore the lived experiences of nursing transfer students during their first year in nursing school and to emphasize the need for a targeted support system within nursing programs. Methods: in-depth interviews with 15 nursing transfer students were analyzed using Colaizzi’s method to identify key adaptation challenges and coping strategies. Results: Four key themes emerged: (1) second-chance pursuit under anxiety, (2) navigating ambiguous uncertainty, (3) standing alienated at the community periphery, and (4) reshaping: embracing professional identification. The themes explain transfer students’ challenges when adapting to nursing education. Conclusions: This study provides valuable insights into the unique experience of nursing transfer students. The findings highlight the importance of structured support systems, mentorship, academic advice, and personalized learning pathways to facilitate a positive transition. Full article

Background: Evidence indicates that pediatric burns are a significant form of trauma. They affect not only children but also their parents, who often experience short- and long-term psychopathological symptoms. The body of knowledge on the impact of hospitalization on parents has expanded; however, there is a dearth of evidence on the dynamics of parental relationships, parental experiences, and how these experiences affect their parenting. Objectives: This study aims to map and summarize the available literature on the repercussions of trauma associated with pediatric burns and hospitalization on parental and family dynamics. Methods: A scoping review will be carried out in accordance with the JBI methodology, based on the PCC. Studies involving hospitalized children (up to the age of 18) who have suffered accidental burns and their parents or caregivers will be included. The literature study will examine the effects of pediatric burn-related trauma on family and parental dynamics, emphasizing interventions and adjustment strategies that support children and families affected by this injury. Studies related to hospital settings and returning home will be included and analyzed by two independent reviewers using a standardized form developed for this study. The databases consulted will be Academic Search Complete, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed/Medline, Collection of Psychology and Behavioral Sciences (via EB-SCO), PsycInfo, Cochrane Library, Embase, and Web of Science (Clarivate). Results: The results will be summarized narratively, presented in tables or diagrams, to highlight key findings related to parental experiences with burned children, the trauma associated with this episode, and its impact on parenting. In addition, strategies developed within the framework of the care partnership will be highlighted. Conclusions: Understanding how family dynamics change after a child suffers a burn injury and goes through the hospitalization process is crucial for nurses to improve their practice. We hope that this review will promote partnership-oriented, family-centered nursing practice in the care of child burn victims and their families, as well as assist in the identification of knowledge gaps in the literature and potential areas for future research and development. Full article

Background: Empathy and assertiveness are two essential soft skills for health professionals such as nurses or physiotherapists. Both professions are characterised by their contribution to preserving and improving health and human care, and for their vocation of service. One of the achievements of the training is the voluntary, conscious, and individually inspired career choice. Objectives: This study aimed to evaluate the empathy, assertiveness, and care vocational levels among undergraduate students enrolled in Nursing and Physiotherapy Degree programmes and to investigate the relationship between these soft skills and the care vocation. Methods: A cross-sectional study of nursing and physiotherapy students was conducted in the 2023/2024 academic year. The Interpersonal Reactivity Index scales for empathy, the Rathus test for assertiveness, and the “Vocation of Service for Human Care” questionnaire were used as study tools. Finally, 226 nursing and physiotherapy students participated after providing informed consent, excluding those on national or international exchange programmes. Results: The empathy, assertiveness, and vocation of service for human care of the students was found to be acceptable. Significant differences were observed according to the gender variable or career among the students, with female students presenting better results in empathy subscales or vocation (p < 0.05). Students who were working or had clinical experience in other professions scored lower on the empathy personal distress subscale (p < 0.05). Conclusions: Both nursing and physiotherapy students demonstrate satisfactory levels of empathy, assertiveness, and vocation for human care. However, gender and previous work experience notably influence these scores. It would be beneficial to conduct long-term studies with educational interventions to train and develop empathy, assertiveness, and vocation for human care. Full article

Background/Objectives: This cross-sectional study aimed to produce an adapted Croatian version of the Negative Behaviors in Health Care Questionnaire and to validate it. Methods: The process comprised the translation, cultural adaptation, and psychometric evaluation of the questionnaire. Clinical specialists and qualified bilingual speakers participated in both forward and backward translation. Face validity was tested. The survey’s original developer approved the final version. The reliability of the questionnaire was assessed using the test–retest method and Cronbach’s alpha coefficient. Exploratory and confirmatory factor analyses and assessments of divergent and convergent validity were conducted. The collected data were analyzed using SPSS 21.0 and R, program version 3.5.2., for Windows. Results: A five-factor structure was obtained and confirmed via CFA, although not all fit coefficients were satisfactory. The internal consistency reliability was 0.86 for the contributing factors and the seriousness of aggression, 0.79 for the use of aggression, 0.95 for the fear of retaliation, and 0.83 for the frequency of aggression; in total, α = 0.88. Test–retest reliability was moderate. All correlations were statistically significant, and the correlation was the highest for seriousness (0.754) and frequency of aggression (0.725) and the lowest for contributing factors (0.528). Test–retest reliability was satisfactory. Statistically significant differences were found when comparing respondents by gender, age, work experience, education, and hierarchical position. Conclusions: The adapted, translated, and validated survey provides a valuable tool for assessing lateral and vertical aggression between and towards nurses in terms of contributing factors, frequency, severity, uses of aggression, and fear of retaliation. Full article

Background/Objectives: Artificial intelligence (AI) is transforming nursing, with generative AI (GenAI) tools such as ChatGPT offering opportunities to enhance education through personalized learning pathways. This study aimed to explore nursing students’ use of generative artificial intelligence (GenAI) and their perceptions of its use in nursing education, including its advantages, disadvantages, and perceived support needs. Methods: This study employed an online survey. The participants were 99 undergraduate nursing students in New York City. Data was collected online through self-report measures using semi-structured, open-ended questions. The data was analyzed using content analysis. Results: Most participants (92%) used GenAI tools to access accurate information, clarify nursing concepts, and support clinical tasks such as diagnoses and health assessments, as well as schoolwork, grammar checks, and health promotion. They valued GenAI as a quick, accessible resource that simplified complex information and supported learning through definitions, practice questions, and writing improvements. However, the participants noted drawbacks, such as subscription costs, over-reliance, information overload, and accuracy issues, leading to trust concerns. The participants suggested financial support, early guidance, and instructional modules to better integrate AI into nursing education. Conclusions: The results indicate that GenAI positively impacts nursing education and highlight the need for guidelines on critical evaluation. To integrate GenAI effectively, educators should consider introductory sessions, support programs, and a GenAI-friendly environment, promoting responsible AI use and preparing students for its application in nursing education. Full article

Background/Objectives: Greek cancer patients deal with high out-of-pocket medical expenses in comparison with the European Union average. All these high costs affect the quality of life of cancer patients, leading to financial toxicity. The purpose of this study is to investigate the association between financial toxicity and quality of life in patients undergoing cancer treatment. Methods: A cross-sectional study was conducted in four hospitals in Greece. The Comprehensive Score for Financial Toxicity (COST) Scale was used for the evaluation of financial toxicity, and the EORTC Core Quality of Life questionnaire (EORTC QLQ-C30) was used for the assessment of quality of life. Quantitative variables were first tested for normality using the Kolmogorov–Smirnov criterion. Spearman correlation coefficients (rho) were used to explore the association of two continuous variables. Multiple linear regression analysis was used with dependent the QoL subscales. Logarithmic transformations of the QoL scales were used for the regression analyses. Internal consistency reliability was determined by the calculation of Cronbach’s α coefficient. All reported p values are two-tailed. Statistical significance was set at p < 0.05 and analyses were conducted using SPSS statistical software (version 27.0). Results: Greater financial toxicity score, i.e., lower toxicity, was significantly associated with greater global health status (rho = 0.34; p < 0.001) and greater physical (rho = 0.37; p < 0.001), role (rho = 0.17; p = 0.001), emotional (rho = 0.34; p < 0.001), cognitive (rho = 0.22; p < 0.001), and social (rho = 0.27; p < 0.001) functioning. Conclusions: There is a strong correlation between a greater financial toxicity score and the quality of life of Greek cancer patients, meaning the lower their financial toxicity, the better their quality of life. Full article

Background: The prevalence of people with obesity is increasing worldwide, facing challenges in terms of discrimination and prejudice across all settings, including healthcare. Objective: The objective of this review is to compare and synthesize recent scientific literature regarding nurses’ behaviors and attitudes toward patients with obesity. Methods: A systematized methodology was employed, conducting a literature search of studies published in the bibliographic resources (Academic Search Complete, CINAHL Complete, Web of Science, and Scopus from 2018 to 2023); using specific terms combined with the Boolean operators, AND and OR. Inclusion criteria: Quantitative, qualitative, or mixed research conducted on nurses and/or nursing students in a context focused on the care of adult patients with obesity. Critical appraisal tools from the Joanna Briggs Institute (JBI) were used to evaluate the included studies, and their level of evidence was also determined. Results: Initially, the search yielded 166 articles, of which 14 were included in this review. The results found focused on the use of scales and tools heterogeneous to each other. The findings can be categorized into two main areas: studies investigating interventions aimed at reducing negative behaviors related to weight bias and prejudice, and studies focusing on assessing these attitudes. The evidence points in a consistent direction: nurses exhibit negative attitudes toward patients with obesity. Conclusions: The need for multilevel strategies, from clinical to academic training, to address this challenge is highlighted, alongside the development of research that complements the current evidence with a deeper and more detailed understanding of this phenomenon. Full article

Background/Objectives: an estimated 1.8 billion people worldwide menstruate, and many face difficulties managing. Young adults often encounter stigma, exclusion, and a lack of resources to manage menstruation comfortably. A review of studies on college students revealed that menstrual symptoms and stigma lead to absenteeism, poorer performance at work and school, and decreased quality of life. This study examines the multifaceted perceptions of a diverse group of young adults aged 18–25 to gain a deeper understanding of the menstrual experience, including cultural stigma, to advocate for personalized care and policy change. Methods: we used snowball sampling and employed a qualitative research methodology integrating a Qualtrics survey (n = 620) and focus groups (n = 50). We used an interpretive phenomenological approach to thematically code participants’ lived experiences by assigning codes to text segments and grouping them by broader themes using the Nvivo 14.23.3 software to understand the underlying meaning and significance of the data. Results: a diverse group of young adults completed the study. Key themes include difficulties attending work/school/social activities related to the physical and mental health challenges associated with menstruation, a cultural stigma, and a lack of access to healthcare and care products during menstruation. Quality of life could be improved with decreased stigma and improved self-care strategies. Limitations include the small sample size and the qualitative study design. Conclusions: this study highlights the need for a holistic approach to supporting menstruation. Recommendations include increasing access to menstrual healthcare, an understanding of cultural differences, and consideration of policy accommodations such as paid time off by workplaces and educational institutions related to menstruation. Full article

Background/Objectives: To address long-standing staffing challenges and elevating care standards in the United States, new legislation will require a minimum of 0.55 h per resident day (HPRD) of registered nurse (RN) care, 2.45 HPRD of certified nursing aide (CNA) care, and a combined total of 3.48 HPRD across any combination of nursing staff. We examine differences in family members’ views of care quality between facilities meeting the minimum staffing requirements and those that do not and whether there is any difference in those associations by facility ownership. Methods: This cross-sectional study utilized public data from 218 Medicare and Medicaid-certified nursing facilities in Maryland, collected in 2023. We used regression analyses to examine the association between staffing requirements and quality of care ratings, considering facility ownership status as a potential moderator. Results: Compared to facilities with CNA staffing levels below the cut off, facilities that met the CNA staffing requirement were rated more favorably by family members in overall quality and across the subdomains of staffing, care, activities, and security. In contrast, meeting the RN 0.55 cut off was not associated with family ratings across any quality domain. A facility for-profit status did not moderate the relationship between staffing and family ratings. Conclusions: These results suggest that CNA staff time is a significant driver of care quality and that non-profit facilities may already be closer to meeting new federal requirements. These findings highlight the need for regulations that support the minimum nursing staffing requirements to enhance care quality. Future research should identify the specific factors contributing to higher quality care in non-profit facilities and explore ways to implement these practices in for-profit settings. Full article

Background: Training on the use of ultrasounds (US) is offered to nurses after their degree in specialization courses or in a work setting. When considering the positive impact of US on patient quality of care, this training should be offered to undergraduate nursing students. The aim of this quality improvement project was to assess the quality of nursing curricula by evaluating the effects of an ultrasound technology educational program (USTep) on nursing students’ knowledge, self-confidence, satisfaction and perceived usefulness of the training for the acquisition of US skills. Methods: 118 nursing students completed a 3-h USTep, that combined a theoretical introduction with simulation training. Data were collected before and after the USTep, using a survey with closed and open-ended questions. Results: After the educational program, a net increase was seen in knowledge about US (pre-test 48.1% vs. post-test 93.4%, p < 0.00001) and in student self-confidence (pre-test m = 1.7 ± 0.9 vs. post-test m = 3.9 ± 0.8, p < 0.001). According to the participants, this training benefited the students (during their training and for future employment opportunities), the patients, and the profession. Lastly, 97% of the sample expressed satisfaction with the training experience. Conclusions: This quality improvement project shows that a 3-h USTep improved undergraduate nursing students’ knowledge, self-confidence, and satisfaction. Full article

Retrospective studies have suggested that performing perioperative abdominal wall exercises may decrease the incidence of parastomal hernias. Objectives: This study seeks to assess the usefulness of supervised preoperative and postoperative abdominal wall exercises in the prevention of parastomal hernia. Methods: An observational study of patients who underwent a stoma, temporary or permanent, between January 2019 and December 2020, was performed. Minimum follow-up was 12 months. During the first 12 months of recruitment, patients were enrolled on a consecutive basis and assigned to the control group, and the remaining patients were assigned to the intervention group. A propensity score matching was performed to obtain totally comparable groups. A set of exercises was designed by the Rehabilitation Department, and their performance was supervised by physiotherapists and stoma therapists. The diagnosis of parastomal hernia was made by physical examination and computed axial tomography. Descriptive statistics of the study group were performed. Subsequently, prediction models for the occurrence of parastomal hernia were created based on binary logistic regression and classification trees. Results: After propensity matching and inclusion criteria, 64 patients were included (colostomy: n = 39, ileostomy: n = 25). Independent prognostic variables for parastomal hernias in colostomy were age (p = 0.044) and perioperative exercises (p = 0.003). The binary logistic regression model based on these variables gave an AUC of 97.6. The classification tree model included only perioperative exercises with an AUC of 92.5%. In the case of ileostomy, perioperative exercises were the only independent prognostic variable identified. The classification-tree-based model reported an AUC of 84%. Conclusions: The performance of supervised abdominal wall training and strengthening exercises may be useful in the prevention of parastomal hernias. Full article

Background/Objectives: The use of simulated learning as a teaching approach has been used and embedded in nursing theoretical curriculum for many years. There is a wealth of evidence to support the positive impact simulated learning or simulated-based education can have on the student experience, developing skill competency and enhancing patient outcomes. However, the evidence on the use of simulation as a replacement for clinical practice learning in undergraduate nursing education is limited. In response to the challenges posed by the COVID-19 pandemic, the authors introduced virtual simulated practice learning experiences (SPLE) for a cohort of year one pre-registration adult and mental health nursing students. The SPLE project aimed to assess the effectiveness of simulated practice learning as a viable alternative to traditional clinical practice learning and to explore student satisfaction with the new practice learning experience approach. Methods: All year one student nurses attending the four simulated practice learning experience (SPLE) weeks were invited to participate and complete a generated questionnaire within the virtual practice environment on their final day of each SPLE week. The questionnaire employed a mix of both quantitative and qualitative questions across key areas to evaluate the effectiveness of the SPLE and explore student satisfaction with their overall practice learning experience. Results: A total of 216 students participated in the simulated practice learning weeks across the spring semester in 2023 with a response rate of 98–100% across all four SPLE weeks. Students reported an overall satisfaction score of 88%, highlighting their preparedness and positive feedback on the organisation, delivery, and content of the SPLE. Qualitative analysis revealed key themes, including the development of transferable skills and personal growth, the value of peer learning, the benefits of a virtual environment, and appreciation of service user and healthcare professional input. Students reported significant personal growth, improved communication skills, and a deeper understanding of holistic care through interactive and collaborative learning experiences. Conclusions: This evaluation underscores the innovative potential of simulated practice learning to enhance nursing practice education, emphasising the importance of integrating emerging technologies and diverse pedagogical approaches. The findings suggest that SPLEs can effectively prepare nursing students for the complexities of clinical practice while addressing the evolving demands of healthcare. Future research should focus on longitudinal studies to assess the sustained impact of simulated learning on clinical experiences and professional development. Full article

Background: Most of the communication training programs developed over the past two decades were monodisciplinary, relied on traditional teaching methods, and targeted the hospital context. Objectives: The aim of this study is to assess the impact of a short, interdisciplinary, experiential-based communication program (Teach-to-Communicate program) targeted at nursing home (NH) personnel with regard to short-term, staff-related outcomes. Methods: This study is part of a larger quality improvement project based on a pre–post single-arm intervention design. We focused on a 6 h residential program involving 30 participants with different scopes of practice working in an NH. Traditional and experiential learning methods were used, including lectures, small group discussions, brainstorming sessions, videos on successful and failed communication, role play, and storytelling based on real cases. The primary outcome was the acquired knowledge of communication strategies and protocols (pre- and post-test quiz). Secondary outcomes were self-reported knowledge, preparedness, confidence, and satisfaction with training (5-point Likert questions). Results: A statistically significant improvement in acquired knowledge with a large size effect (0.7, p < 0.001) was observed. Self-reported preparedness and confidence ameliorated for all measured communication skills and topics, with the highest effect size registered for self-reported preparedness and confidence in engaging in difficult communication (both 0.7, p < 0.001). Participants were highly satisfied with the training, and particularly with the use of video cases (mean 4.6, SD 0.6) and the relevance to clinical practice (mean 4.7, SD 0.5). Conclusions: The Teach-to-Communicate program holds promise for improving knowledge and self-confidence regarding difficult communication among NH staff, and highlights the utility of video cases in communication skills training. Full article

Background: Effective communication in healthcare is essential for ensuring teamwork that is continuous, effective, and efficient. It plays a crucial role in supporting comprehensive and holistic care for patients while also guaranteeing the safety and satisfaction of the services provided. Objective: To determine the relationship between effective communication (as well as its dimensions: transmission of institutional culture, source of employee motivation, and facilitation of teamwork and conflict resolution) and teamwork among nurses in a national hospital in Peru. Methods: The research employed a quantitative, correlational, cross-sectional approach with a non-experimental design. The study population consisted of 328 nurses working in various hospital departments between January and October 2024. Data were collected using two questionnaires: The first assessed effective communication through three dimensions: transmission of institutional culture, source of employee motivation, and facilitation of teamwork and conflict resolution. The second instrument evaluated teamwork across three dimensions: institutional context, composition, and process. Results: A very strong positive correlation was observed between effective communication and teamwork among nurses, with a coefficient of 0.925 and a p value < 0.01. Conclusions: The study found a strong link between effective communication and teamwork among nurses. It underscores the role of communication, organizational culture, and motivation in strengthening teamwork, which enhances patient care and healthcare delivery. The findings highlight the impact of institutional culture, motivation, and conflict resolution, emphasizing soft skills and ethical behavior in improving team dynamics and organizational strategies. Full article

Background/Objectives: The global nursing shortage encompasses issues such as the uneven nurse distribution in low- and middle-income countries, nurse outflow to other countries, and nurse retirement in developed countries, necessitating effective retention strategies. Our objective was to clarify the changes in facility selection reasons among Japanese nurses after changing jobs and the personal attributes influencing facility selection. Methods: In January 2023, an online survey was conducted among licensed practical nurses, registered nurses, midwives, and public health nurses in Japan. The survey items included personal attributes (age and sex), information on ≤five employment facilities, and facility selection reasons. The variations in facility selection reasons by facility number were analyzed using a generalized linear model with a binomial distribution. A logistic regression analysis was conducted with personal attributes and reasons for workplace selection as the independent and dependent variables, respectively. Results: In total, 721 participants were included; 90.8% selected hospitals as their first place of employment. As nurses changed jobs, they increasingly selected non-hospital facilities, including nursing homes, nursery schools, and government agencies. With multiple job changes, the facility selection reasons included “good location for commuting”, “good salary”, and “convenient working style”. Among personal attributes, “age”, “sex”, “age at employment at the facility”, “educational background”, “number of children”, and “living alone” influenced workplace choice reasons. Conclusions: Considering the study results, country-specific demographic trends, medical policy changes, and nursing-shortage-related causes, medical facility managers and policymakers should devise appropriate employment conditions and develop recruitment strategies, especially for situations with severe nursing shortages. Nurses can learn from the career choices of others to manage their own careers. Full article

Background: The prevalence of chronic health problems in childhood, such as food and respiratory allergies, as well as endocrine and skin disorders, has increased globally. Parents and children experience difficulties in managing their illness that reduce their quality of life and increase the presence of negative feelings such as fear or anxiety during school hours. Objectives: The aim of this study was to describe and understand the parents’ experiences of the management of children with chronic health problems during school hours. Methods: A qualitative descriptive study design was used. Semi-structured interviews were conducted with 17 parents (1 male and 16 female) who have children with a chronic health problem between September 2022 and June 2023. The data were analyzed with the help of a qualitative data analysis software. The COREQ checklist was used to develop the study. Results: Two categories and four subcategories emerged from the data analysis: (1) Parents’ Perceptions, with the subcategories 1.1., The School Nurse, and 1.2., Educational Environment; and (2) Chronic Pediatric Health Problems, with the subcategories 2.1., Emotional Impact, and 2.2., Lack of Resources. Conclusions: Children with chronic health problems are unprotected during school hours due to the absence of a school nurse. Parents and teachers have to cope with their care without the necessary knowledge, which makes it difficult to manage children with chronic health problems in the school environment. Full article

Background/Objectives: The nursing profession is expected to undergo substantial transformations in the coming years due to rapidly evolving sociocultural, environmental, and technological changes. Defining and assessing nursing competencies are essential to ensuring high-quality care and fostering professional development. This systematic review aims to explore the future nursing competencies required and the sociocultural factors influencing their evolution. Methods: A comprehensive systematic search was conducted in several indexed databases PubMed, CINAHL, Scopus, and Web of Science databases using keywords such as “nursing competencies”, “future”, “healthcare systems”, and “demographic change”. Studies published within the last five years were included, and a rigorous quality assessment was performed. Results: The findings suggest that key sociocultural and technological factors—including environmental sustainability, technological advancements, innovation, globalization, urbanization, policy uncertainty, and demographic shifts—will significantly shape the development of nursing competencies. It is projected that nearly 70% of the nursing workforce will operate in highly unpredictable environments. The review highlights the need to develop interpersonal, higher-order cognitive, and system-level competencies, alongside complementary skills in personal and customer services, decision making, technology utilization, creativity, and scientific methodologies. Conclusions: Addressing the future challenges in nursing requires a holistic and strategic approach, including a cultural shift within the profession supported by targeted policies and sustained investment in education and continuous professional development. Training systems should prioritize the development of core competencies and promote lifelong learning to ensure adaptability in an evolving healthcare landscape. Full article

Background: Artificial intelligence (AI) has been increasingly employed in healthcare across diverse domains, including medical imaging, personalized diagnostics, therapeutic interventions, and predictive analytics using electronic health records. Its integration is particularly impactful in critical care, where AI has demonstrated the potential to enhance patient outcomes. This systematic review critically evaluates the current applications of AI within the domain of critical care nursing. Methods: This systematic review is registered with PROSPERO (CRD42024545955) and was conducted in accordance with PRISMA guidelines. Comprehensive searches were performed across MEDLINE/PubMed, SCOPUS, CINAHL, and Web of Science. Results: The initial review identified 1364 articles, of which 24 studies met the inclusion criteria. These studies employed diverse AI techniques, including classical models (e.g., logistic regression), machine learning approaches (e.g., support vector machines, random forests), deep learning architectures (e.g., neural networks), and generative AI tools (e.g., ChatGPT). The analyzed health outcomes encompassed postoperative complications, ICU admissions and discharges, triage assessments, pressure injuries, sepsis, delirium, and predictions of adverse events or critical vital signs. Most studies relied on structured data from electronic medical records, such as vital signs and laboratory results, supplemented by unstructured data, including nursing notes and patient histories; two studies also integrated audio data. Conclusion: AI demonstrates significant potential in nursing, facilitating the use of clinical practice data for research and decision-making. The choice of AI techniques varies based on the specific objectives and requirements of the model. However, the heterogeneity of the studies included in this review limits the ability to draw definitive conclusions about the effectiveness of AI applications in critical care nursing. Future research should focus on more robust, interventional studies to assess the impact of AI on nursing-sensitive outcomes. Additionally, exploring a broader range of health outcomes and AI applications in critical care will be crucial for advancing AI integration in nursing practices. Full article

Background: Sleep quality is crucial for patient recovery and well-being, yet hospitalized patients often suffer from poor sleep due to environmental disruptions, clinical routines, and psychosocial stressors. While these challenges are well-documented, qualitative insights into nurses’ perspectives—essential frontline providers shaping the sleep environment—are scarce, especially within rapidly evolving healthcare systems like Saudi Arabia’s. This study explores nurses’ perceptions of factors influencing patient sleep quality in a private hospital in Al Ahsa, Saudi Arabia, and identifies strategies for improvement. Methods: We conducted a qualitative, cross-sectional study using semi-structured interviews with 14 registered nurses from diverse nationalities, specialties (Obstetrics/Gynecology, Medical-Surgical, Pediatrics, Intensive Care, Orthopedics, Bariatrics), and experience levels. Interviews were conducted in Arabic or English, audio-recorded, transcribed, and thematically analyzed using ATLAS.ti software. Roy’s Adaptation Model guided the examination of environmental, patient-specific, and systemic factors affecting sleep. Findings: Four primary themes emerged: (1). Environmental Factors: noise from alarms, equipment, family presence, and late-night activities, along with abrupt lighting changes, consistently disrupted sleep. (2). Patient-Specific Factors: pain, emotional distress, cultural expectations, and family involvement influenced sleep experiences. (3). Systemic and Contextual Factors: language barriers, infrastructural disparities between private and governmental hospitals, and limited resources can impeded effective sleep-promoting strategies. (4). Role of Health Technology: nurses recognized the potential of innovations like smart lighting and wearable monitors to enhance sleep quality but faced challenges in implementation due to knowledge gaps and limited familiarity. Roy’s Adaptation Model highlighted how effective adaptation through physiological and cognitive–emotional pathways, as observed by nurses, was facilitated or hindered by these factors. Conclusions: Enhancing in-hospital sleep quality requires a holistic, culturally sensitive approach that integrates environmental modifications, patient-centered care, and systemic improvements. Strategic investments in staff communication training, infrastructural upgrades, language support services, and the adoption of health technologies can promote adaptive responses and optimize patient rest. By leveraging theory-driven insights and context-specific strategies, healthcare systems—particularly those undergoing rapid development—can better support nurses in fostering restorative sleep environments as a fundamental component of patient-centered care, thereby enhancing patient recovery, satisfaction, and overall well-being. Full article

(1) Background: Self-medication, defined as the use of medications without professional supervision, is a common practice that presents both potential benefits and significant risks. This study analyzes the prevalence, patterns, and determinants of self-medication among health professionals in Spain. (2) Methods: A cross-sectional descriptive design was employed with 438 health professionals, predominantly women (81.1%), with a median age of 42 years. The majority of the healthcare workers were nurses (45%). (3) Results: The results revealed a high prevalence of self-medication (59.4%). Analgesics and anti-inflammatory drugs were the most commonly used. Age and professional knowledge emerged as significant factors influencing this behavior. The main reasons for self-medication included the mildness of symptoms, easy access to medications, and previous successful experiences. Digital sources, especially websites, were the most consulted. Confidence in artificial intelligence tools as a clinical resource was moderate, with 18% of participants consulting AI tools, a rate comparable to the 19.5% for scientific databases. Logistic regression analysis identified age, knowledge of recommended doses, and perceived efficacy as significant predictors, while concern about risks acted as a protective factor. (4) Conclusions: This study highlights the need for educational interventions aimed at promoting responsible self-medication practices and mitigating associated risks among healthcare professionals. Full article

Background/Objectives: The COVID-19 pandemic has adversely impacted the mental health of nurses worldwide. Nurse burnout results from chronic workplace stress and is characterized by exhaustion, negative or cynical feelings about work, and a diminished sense of accomplishment. This can lead to turnover intention. Therefore, psychological capacities, such as psychological flexibility, that could help nurses regulate and minimize the impact should be studied. This study aimed to compare burnout, insomnia and turnover intention among nurses from an Eastern and Western cultural context and to investigate the role of psychological flexibility as a protective factor against mental health and related problems such as insomnia and turnover intention. Methods: Nurses from Hong Kong (n = 158) and Switzerland (n = 294) involved in patient care during the COVID-19 pandemic participated in an online mental health survey. Results: We observed high levels of burnout, subthreshold insomnia and turnover intention in nurses from both Switzerland and Hong Kong, with higher burnout rates among Hong Kong nurses and higher turnover intentions among nurses from Switzerland, and that psychological flexibility is a crucial factor that may protect nurses from burnout and insomnia. Conclusions: The nurses from both regions involved in patient care one year after the onset of the pandemic suffered from poor mental health. Psychological flexibility was identified as a critical factor in improving nurses’ mental health. The results of this study should be incorporated into health promotions for nursing professionals and help develop specific and effective interventions for practical nursing application. Full article

Background/Objectives: Patient and family involvement in bedside handover is a requirement of the national standards on patient safety and quality in Australia. To ensure patient-and-family-centred care, it is essential to understand how patients and families perceive their involvement in nursing bedside handover and what difficulties they face when participating. This study aimed to explore patient and family perceptions of their involvement in nursing bedside handover. Methods: We employed a qualitative descriptive study design with in-depth and semi-structured interviews. Using purposive and convenience sampling, 24 patients and family members were recruited from two adult hospitals in Western Australia between November 2021 and February 2022. The data were thematically analysed. Results: Participants had mixed experiences that overlapped with their individual perceptions, needs, and experiences. Their responses were grouped into three major themes with sub-themes: (1) discovering new nursing care approaches; (2) seeing the value of involvement in bedside handover; and (3) barriers hindering patient and family involvement in bedside handover. The findings revealed that patients and families valued their involvement in nursing bedside handover. However, several factors challenged their participation, including a lack of awareness about their right to participate, the timing of handovers, the nurse’s approach, and fear of asking questions. Conclusions: The findings serve as a guide for evidence-based practice and may significantly influence policy and practice in nursing bedside handover, potentially enhancing patient-and-family-centred care. While considered best practice, the consistent involvement of patients and their families in nursing bedside handover is not routinely achieved and is implemented to varying extents. Full article

Trillium Health Partners (THP) is a hospital network that serves the Mississauga region of Ontario, Canada, and sees nearly 1.7 million patient visits each year. THP is also a provider of highly specialized services to the region and a fully-fledged academic teaching center, with embedded research and innovation. Background/Objectives: Highly trained, skilled, and experienced nurses are foundational to THPs ability to meet the complex care needs of our patients across specialized programs. In 2024, 50% of the nursing workforce at THP was noted to have less than five years of experience. This generation of nurses are reporting high levels of burnout and are at greater risk of leaving the profession. The more experienced nurses are also facing burnout due to the continued pressures and demands in the workplace, having to manage an increasingly complex patient assignment, while providing mentorship to more novice nurses. Based on the existing literature and our collective experience at THP, we have developed the Transition to Independent Practice Support (TIPS) program, a multi-pronged approach to bolster support for our nursing workforce. The TIPS program at THP is designed to address knowledge gaps and enhance clinical competence among new and aspiring nurses. The primary aim of this study is to evaluate the efficacy of the TIPS program in facilitating the transition of novice nurses to independent and competent practitioners, utilizing the Kirkpatrick Model of Evaluation The specific objectives include (a) assessing participants’ reactions to the TIPS program; (b) measuring the increase in nurses’ knowledge and confidence following program participation; (c) evaluating changes in nurses’ behavior and practice post-program; and (d) determining the program’s impact on nurse retention and quality of patient care. Methods: Grounded in Meleis’s Transition Theory, the program combines webinars, simulations, clinical rounding, and mentorship to build resilience, decision-making, and confidence. Evaluative measures, based on the Kirkpatrick Model, assessed participant satisfaction, learning outcomes, behavior changes, and retention. Results: From September 2023 to March 2024, 388 interdisciplinary participants attended the program, including nursing students (56%), registered nurses (24%), registered practical nurses (14%), and aspiring nurses in other interprofessional roles (6%). Participants expressed high satisfaction with the program, achieving a mean reaction score of 4.80 (SD = 0.2921). Ninety-five percent found the sessions relevant, and 98% rated the facilitators as knowledgeable. Self-reported confidence significantly increased across all topics, with overall mean confidence scores rising from 2.94 to 4.52 (p < 0.0001, Cohen’s d = 3.01), demonstrating a strong impact on skill acquisition and application. Behavioral evaluations through simulations, competency checklists, and follow-up touchpoints confirmed improved clinical performance, with participants achieving 100% compliance to nursing skills during simulations and sustained confidence at three-month follow-ups. Since the program’s implementation, nursing turnover rates decreased from 9.52% to 7.7% by March 2024, with 100% of RNs, RPNs and IENs of TIPS participants retained within six months. Conclusions: This paper outlines the TIPS program and the diverse teaching and learning methodologies used in the design and program implementation to ultimately support the transition experience of the new gradate nurse into acute care. Preliminary outcomes are discussed including nursing retention rates, nurses’ knowledge, confidence, and skill levels. Full article

Background: Physical inactivity among older adults persists as one of the global burdens. Older adults’ physical activity (PA) levels decline simultaneously with age, causing health problems and poor outcomes. Immersive interventions, such as mixed reality virtual coaches, are gaining the potential to provide innovative solutions to prevent physical inactivity among older adults. However, an in-depth understanding of older adults’ experience in using virtual-coach-driven physical exercise programs remains unexplored. Purpose: This study explored the experiences of community-dwelling older adults in using a virtual-coach-driven physical exercise program. Design: This study applied a phenomenological design using the qualitative approach to determine the lived experiences of community-dwelling older adults about the mother project, the “Move and Groove for Older Adults Program” (Hataw at Sigla para kay Lolo at Lola), a virtual-coach-driven physical exercise program using MR. A semi-structured interview guide was crafted consisting of three domains (acceptability, barriers, and facilitators), each with two open-ended questions. MAXQDA was used to thematically analyze the qualitative data. Results: Nine key informants shared their experiences with the virtual coach-driven physical exercise program using mixed reality. Four themes were identified describing their experiences with the program: (1) “Looking around”: Exploring MR technology, (2) “Looking after”: Engaging with MR exercise peers, (3) “Looking at”: Examining issues with MR technology devices, and (4) “Looking Ahead”: Envisioning the future of MR exercises. Conclusions: The findings of this study introduced new concepts and challenged old notions regarding older adults’ technological engagement. The virtual-coach-driven physical exercise program enabled the participants to explore the novel methodology, enhance peer relationships, examine potential issues, and envision a future of possibilities using the technology. These outcomes are pertinent for progressing studies, scholars, and technology developers in incorporating MR into gerontechnology for wellness and fullness of life in the aging population. The mother project of this study was retrospectively registered [ID NCT06136468]. Full article

Background/Objectives: School nursing is a nursing practice focused on promoting child health within the school and community environment, integrating healthcare with the educational process. The aim was to explore the experiences of nurses and teachers regarding the implementation of a school nursing pilot programme in primary education in the Canary Islands (Spain). Methods: A phenomenological study was conducted during the 2023/2024 academic year. In-depth interviews were conducted between May and June 2024 until data saturation was achieved. The interviews were transcribed and analysed using descriptive and interpretative thematic analysis. Intentional and co-occurrence coding methods were employed, followed by triangulation using Atlas-Ti software (version 24). Ethical approval was obtained (code: 2023-216-1). Results: A total of 21 informants (7 nurses and 14 teachers) were interviewed. Nurses revealed eight subthemes grouped into two main themes: Role of School Nurses (workload, school nurses’ experiences, career opportunities, and the school nurse profile) and School Nursing Project (suggested improvements, identified weaknesses, time management, and improvement needs). Regarding teachers, six subthemes were identified, also grouped into two main themes: Role of School Nurses (approach to school nursing and the importance of the presence of school nurses) and School Nursing Project (expectations, improving children’s health, school health, and experiences from the pilot programme). Conclusions: The pilot programme has been well received, showing a positive impact on students’ health. While successfully integrating nurses into schools, improvements are needed in working conditions, resource allocation, and specialized training to enhance its effectiveness and sustainability. Strengthening inter-professional collaboration between healthcare and education sectors and involving teachers in planning health activities are essential. Expanding the coverage and ensuring a consistent presence of school nurses would further build trust, improve chronic health management, and promote healthy habits from an early age. This programme illustrates the potential of nurses to transform schools into spaces for comprehensive health promotion. Full article

Background/Objectives: Undergraduate nursing students report encountering significant challenges when they perform preplanning for clinical days. The literature lacks evidence regarding this educational model for clinical training, yet faculty continue to use it despite the lack of evidence that supports it. This study explored undergraduate nursing students’ perceptions of their preclinical training activities. Methods: A quasi-experimental, after-only, nonequivalent control group design was employed at a public nursing school in an urban setting. A total of 110 undergraduate nursing students enrolled in an advanced medical–surgical course. Participants were divided into two groups based on their preparation approach for clinical practice. Data were collected using a paper-and-pencil survey at the end of the course’s clinical rotation. The survey comprised three sections: (1) sociodemographic information, (2) the nursing clinical education tool (NCET) developed for this study, and (3) two open-ended questions focusing on the pros and cons of preplanning and reflective care approaches. The responses were analyzed and compared using a nonparametric two-independent-samples Mann–Whitney U test. Results: The findings indicated that students in eight out of ten nursing clinical education survey categories favored the reflective care approach. No differences were found between groups concerning class grade point average (GPA), the National Council Licensure Examination (NCLEX) passing rate, or standardized tests. Conclusions: The reflective care approach was perceived more favorably than preplanning. Engaging in clinical reasoning strategies requires educators to reconsider how students interact with clinical education. Further research is needed to develop evidence-based methods to enhance the clinical learning experience and promote patient safety. Full article

Background/Objectives: Coping strategies are influenced by sociocultural factors, and an understanding of how the Brief-COPE functions within the Chinese student population is important for its validity and reliability. This study aimed to explore the factor structure of the Brief Coping Orientation to Problems Experienced Inventory (Brief-COPE) in Chinese nursing students. Methods: A cross-sectional study design was adopted. A total of 284 college nursing students, aged 18 years or older, were recruited from a medical university in China using convenience sampling. Exploratory factor analysis (EFA) was conducted to identify the underlying domain structure of the Brief-COPE within those students. This study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement. Results: The Brief-COPE demonstrated robust validity, revealing eight distinct factors: positive reframing coping, avoidant and passive coping, seeking social support, self-blame and emotional distress coping, denial and deflective coping, spirituality and humor coping, avoidance and emotional release coping, and adaptive acceptance with distraction. The scale exhibited good internal consistency, as indicated by a Cronbach’s alpha of 0.759. Conclusions: The Brief-COPE is a valid tool for assessing coping strategies in Chinese nursing students. Nursing educators could benefit from training aimed at enhancing the use of appropriate strategies. Also, culturally tailored interventions, such as peer support groups and mentorship programs, could further promote coping skills and improve the emotional well-being of these students. Full article

Background: Academic integrity is an important component of nursing education, bridging academic ethics with professional practice. This study evaluated the effectiveness of a co-designed Academic Integrity digital serious game in improving nursing students’ self-efficacy related to academic integrity, academic offenses, professionalism, and artificial intelligence use. Methods: A pre-test/post-test design was employed, using a bespoke questionnaire to assess 303 first-year nursing students’ self-efficacy before and after playing the game. The questionnaire covered five subscales: academic integrity standards, academic offenses, professional values, feedback processes, and AI use in academic work. Results: Statistically significant improvements were observed across all subscales following the intervention, indicating enhanced self-efficacy in understanding and applying academic integrity principles, recognizing academic offenses, demonstrating professional behaviors, utilizing feedback, and appropriately using AI in academic contexts. Conclusions: The Academic Integrity digital serious game has the potential to be an effective tool for enhancing nursing students’ self-efficacy in the areas of academic and professional ethics. This approach shows promise for integrating academic integrity-based education in nursing curricula and preparing students for the ethical challenges of modern healthcare practice. This study was not registered. Full article