Nurs. Rep., Volume 15, Issue 5 (May 2025) – 23 articles

Background: Medication-related problems (MRPs) are common among home-care patients urgently needing improvement. Due to limited resources, patients with the greatest risk of MRPs should be prioritised for interventions. Objectives: We sought to develop a collaborative assessment tool for nurses and pharmacists to identify home-care patients at high risk of developing MRPs. Methods: Using Pubmed^® for a first scoping literature review, we sought existing tools identifying patients at risk of MRPs or prioritising patients for clinical pharmacy services. Extracted items were prioritised in a first interprofessional Delphi round. Results from the first Delphi round were complemented by individual risk factors identified in a second scoping literature review and again submitted to the expert panel in a second Delphi round. Each item was rated for its relevance to identify home-care patients at risk of MRPs. The highest scoring factors were combined into an interprofessional assessment tool. Results: Literature review one yielded 19 risk tools and six lists containing potentially inappropriate medications. The 78 resulting risk factors were submitted to experts (five pharmacists, five physicians, five nurses) in Delphi round one. Since the identified tools did not fit the scope (interprofessional assessment in home care) entirely, the results of Delphi round one were complemented with individual risk factors identified in a second literature review, leading to 82 potential risk factors for Delphi round two. Experts decided on a 15-item tool for future pilot testing—the doMESTIC RISK tool. It incorporated diverse factors potentially influencing medication safety: demographic information, social context, diagnosis, specific medication and health care resources use. Conclusions: With expert feedback from a Delphi process, we developed a 15-item tool to help nurses and pharmacists jointly identify home-care patients at a high risk of MRPs. Validation of the doMESTIC RISK tool will be imperative to verify its value in clinical practice. Full article

Background: Stress affects 45% of NHS staff. More research is needed to explore how to develop resilient mental health nurses who face multiple workplace stressors, including interacting with distressed clients. Higher Education Institutions are uniquely placed to introduce coping skills that help reduce anxiety and increase confidence for pre-registration nurses entering placements for the first time. Methods: A convenience sample of first year mental health student nurses (whole cohort), recruited before their first clinical placement, were invited to participate. Following a mixed methods design, we developed a 360-degree virtual reality (VR) video, depicting a distressed service user across three scenes, filmed in a real-life decommissioned in-patient ward. Participants followed the service user through the scenes, as though in real life. We used the video alongside a cognitive reappraisal/solution-focused/VERA worksheet and supportive clinical supervision technique to explore students’ experiences of VR as an educative tool and to help build emotional coping skills. Results: N = 21 mental health student nurses were recruited to the study. Behavioural responses to the distressed patient scenario were varied. Students that had prior experience in health work were more likely to feel detached from the distress of the service user. Although for some students VR provided a meaningful learning experience in developing emotional awareness, other students felt more like a ‘fly on the wall’ than an active participant. Empathetic and compassionate responses were strongest in those who perceived a strong immersive effect. Overall, the supportive supervision appeared to decrease the anxiety of the small sample involved, but confidence was not affected. Conclusions: The use of 360-degree VR technology as an educative, classroom-based tool to moderate anxiety and build confidence in pre-placement mental health nursing students was partially supported by this study. The effectiveness of such technology appeared to be dependent on the degree to which ‘immersion’ and a sense of presence were experienced by students. Our cognitive reappraisal intervention proved useful in reducing anxiety caused by ‘the patient in distress scenario’ but only for students who achieved a deep immersive effect. Students with prior exposure to distressing events (in their personal lives and in clinical settings) might have developed other coping mechanisms (e.g., detachment). These findings support the idea that ‘presence’ is a subjective VR experience and can vary among users. Full article

Background: There is a notable lack of Communication of Bad News (CBN) training for nurses, along with the absence of validated tools to assess this. The aim of this research is to design and validate an instrument to assess the communication of bad news among nursing professionals in Spain: the “Communication of Bad News in Nursing (CBNN)” tool. Methods: A multilevel nursing panel of experts participated in creating CBNN. A cross-sectional study was carried out on 218 Spanish nurses. Then, an Exploratory Factor Analysis (EFA), Confirmatory Factor Analysis (CFA), and a convergent validity study were carried out with the Scale of Communication Skills in Nursing Professionals in the Spanish Environment (EHC), and a reliability study using internal consistency (Cronbach’s α) and Coefficient of Intraclass Correlation (ICC). Results: The KMO test gave an adequate value, and Bartlett’s sphericity test was significant. The EFA identified four components (empathy and perception; environment preparation, invitation, and strategy; information given and the act of communicating; and communication method) that explained most of the variance. A good fit was observed in the CFA for most of the evaluated indicators. CBNN correlated positively with EHC and was statistically associated with considering it necessary to be trained in CBN or degree of preparation. Cronbach’s α value was excellent. The ICC of absolute agreement after 96 h was good. Conclusions: The Communication of Bad News in Nursing questionnaire can be considered an effective tool for assessing the communication of bad news in nursing. It serves as a self-assessment tool for nurses to identify their strengths and areas for improvement in attitudes, knowledge, and skills regarding CBN. Full article

Background/Objectives: Care-oriented perspectives in the LGBTIQ+ community are essential to ensure adequate and comprehensive health care. This population faces multiple barriers imposed by society, including discrimination in access to healthcare services. This research aims to analyse the perspective of nursing students in relation to the provision of care for people with sexual and gender diversity. Methods: A qualitative phenomenological research-action study was conducted. Data were collected using a semi-structured face-to-face interview consisting of 23 questions. The interviews were transcribed, read thoroughly and analysed. Results: Forty students were interviewed, and four main themes emerged: (1) personal perspective, (2) professional and disciplinary training, (3) nursing education and (4) health implications. The results show that students have mixed perspectives and attitudes towards LGBTQ+ populations, although they are interested in receiving more LGBTQ-focused training. Furthermore, respondents reported that the training received in the degree course and the preparation of lecturers in relation to caring for LGBTQ+ people are lacking. Finally, it emerged that inequalities in access to health services can still be observed and that there is a need for the development of manuals that are at the forefront of comprehensive health in this population. Conclusions: Based on the results, the implementation of Madeleine Leininger’s Sunrise model is suggested. Acceptance of sexual and gender diversity is essential to ensure the elimination of inequalities and make care a transformative process. Finally, education on these aspects needs to be implemented by including activities such as practical training scenarios, workshops and conferences to highlight the specific needs of the LGBTIQ+ population. Full article

Background/Objectives: The complexity of modern healthcare requires teamwork. Healthcare teams must be cohesive to ensure efficient and quality care. The objective of this study was to validate the Spanish short version of the Group Environment Questionnaire (GEQ) in undergraduate nursing students undergoing clinical simulation training. Methods: The psychometric properties of the questionnaire were analyzed. We began with a statistical analysis of the items. Internal consistency was assessed using McDonald’s omega coefficient. Test-retest reliability was determined using Spearman’s correlation coefficient. An exploratory factor analysis was performed using the principal components analysis method with varimax rotation. Finally, a confirmatory factor analysis of the proposed theoretical models was performed to select the most appropriate one using the weighted least squares method adjusted for mean and variance (WLSMV) and goodness-of-fit indices. Results: The questionnaire items showed a standard deviation higher than 1 and a negative skewness lower than 0.5. Internal consistency and test-retest reliability were higher than 0.8. The item-total correlation coefficient values were above 0.44. The exploratory factor analysis confirmed the presence of four factors, each with three items. Confirmatory factor analysis determined that the four-factor cohesion model was the one that obtained the best fit. Conclusions: The Spanish short version of the Group Environment Questionnaire (GEQ) is a valid and reliable instrument for analyzing group cohesion in teams of nursing students undergoing clinical simulation training. Full article

Background: Nurses report that they often must perform activities outside their area of expertise, referred to as “non-nursing tasks”. The time spent on simple tasks undermines nursing capacity, which is already challenged by the dramatic shortage of nurses. Performing non-nursing tasks affects nurses’ satisfaction and their intention to stay. However, despite their relevance, there is no summary of studies on non-nursing tasks. The aim of this study is to summarize available evidence on characteristics of non-nursing tasks, their antecedents, and consequences, to identify gaps in the existing literature and to make recommendations for management, education, practice, and nursing research. Methods: A scoping review will be conducted using Arksey and O’Malley’s methodological framework. The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews, and the Patterns, Advances, Gaps, Evidence for practice and research framework will be used to report and summarize the findings. Results: Findings will provide a map regarding the main patterns of research in this area and the evidence produced to date. Two main lines of findings are expected, namely the conceptual and the empirical. The former may contribute to the understanding of the terminology and concept used so far to clearly express non-nursing tasks; the empirical evidence may shed light on frequencies, instruments, reasons, and effects. Discussion: An analysis of non-nursing tasks will provide healthcare organizations with a conceptual framework of all variations in the phenomenon and will help managers to identify the activities that will fall within this conceptual construct. The establishment of a research strand in this field, based on a science-based review involving international stakeholders, can strengthen global action to prevent the occurrence of non-nursing tasks. Full article

Background: Chronic kidney disease (CKD) has a significant impact on patients’ physical, psychological, and social well-being. Emotional disorders are common and contribute to a higher prevalence of symptoms compared to that in the general population. This study aimed to analyze the relationship between the emotional profiles and symptomatology in patients undergoing hemodialysis (HD). Methods: A multicenter, cross-sectional, observational/analytical study was developed in seven centers of the Spanish Renal Foundation in the Community of Madrid (Spain). The study protocol was reviewed and approved by the Clinical Research Ethics Committee of Hospital Clínico San Carlos, Madrid (C.I. 20/685-E). In the study, two validated measurement scales were used: the Mood Rating Scale (EVEA) to assess the “emotional profile” and the Palliative care Outcome Scale, Renal Symptoms (POS-S Renal) to evaluate “symptomatology”. Results: The sample (245 patients) was predominantly male (65.7%; n = 161), with a mean age of 63.52 years (SD = 14.99) and an average HD treatment duration of 81.44 months (SD = 96.62). The analysis of the symptom–emotion relationships revealed that patients with a sadness–depression profile had a higher probability of experiencing weakness or a lack of energy (OR = 1.741; CI 95% 1.01–3.00) and feelings of depression (OR = 3.236; CI 95% 1.98–5.30). Additionally, patients with an anger–hostility profile exhibited a significant association with pain (OR = 3.463; CI 95% 1.34–8.94) and excessive sleepiness (OR = 3.796; CI 95% 1.21–11.95), indicating that this emotional state substantially increases the likelihood of developing these symptoms. Conclusions: The emotional profiles of CKD patients undergoing HD significantly influence their symptomatology. While positive emotions may play a protective role in preventing debilitating symptoms, negative emotions increase the risk of their onset. These findings highlight the importance of addressing emotional well-being as part of comprehensive care for HD patients. Full article

Background/Objectives: The progressive increase in the aging population highlights the need for interventions aimed at preserving cognitive health and overall well-being in older adults. This study aimed to assess the impact of a structured cognitive training program on psychological well-being, executive function performance, and Brain-Derived Neurotrophic Factor levels (BDNF) in older adults from a Mexican geriatric center. Methods: A quasi-experimental pretest–posttest design with a nonequivalent control group was conducted. Thirty-two older adults were assigned either to a cognitive stimulation intervention group or a control group. The intervention consisted of 120 individually structured sessions, each lasting approximately 60 min, delivered five times per week over 24 weeks. Independent neuropsychologists, blinded to group allocation, assessed executive function (BANFE-3), depressive symptoms (Yesavage Geriatric Depression Scale), autonomy in daily living (Barthel Index), and quality of life (WHOQOL-OLD) before and after the intervention. Serum BDNF levels were also measured. Results: The intervention group showed significant improvements in executive function, depressive symptoms, independence in daily activities, and quality of life, while the control group showed no changes. Additionally, the intervention group showed an increase in BDNF expression post-intervention. Conclusions: The cognitive stimulation program effectively improved cognitive performance, emotional well-being, autonomy, and quality of life in older adults. These findings highlight the importance of integrating structured cognitive stimulation into geriatric care. For nursing practice, this underscores the key role nurses can play in delivering cognitive interventions to promote cognitive health, independence, and emotional stability among institutionalized and non-institutionalized older adults. Full article

Background/Objectives: While drug dosage calculation is vital in nursing, research indicates nursing students often struggle with necessary mathematics competencies, a gap not previously explored in the Arab world. This study assessed the basic mathematical skills of baccalaureate nursing students in a branch of a Saudi Arabian public university and compared the findings with studies conducted in other countries, which have consistently reported better performance. By highlighting these disparities, this study underscored the need for global educational reforms to ensure safe nursing practices. Methods: This was a cross-sectional study. Three hundred and thirty students were invited; consenting students completed a mathematics experts-validated 45-question test covering four key areas: numbers and operations, data interpretation, measurement, and algebraic applications. Descriptive and inferential statistics were applied. The Mann–Whitney U test was used to detect differences in scores based on gender. An independent-samples Kruskal–Wallis test was conducted to compare the three student groups simultaneously. As this test was statistically significant, post hoc pairwise comparisons were performed to assess differences in scores between the first and second, first and third, and second and third levels of study. Results: A response rate of 40.6% was achieved. Scores ranged from 3 to 58 (median: 18, 27%), with only 2% passing (≥60%). Significant differences in scores were found between genders (p = 0.037) and across study levels (p = 0.002). Overall, 25 (56%) items were difficult, while 20 (44%) were moderately difficult. Conclusions: The low median score underscored a critical need for interventions to improve mathematical competencies in nursing students, affecting medication safety in healthcare systems. Full article

Background: This study extends the theoretical framework based on the Cognitive–Affective Model of Immersive Learning (CAMIL) by incorporating flow state and cognitive absorption to investigate the effectiveness of virtual reality (VR) in nursing education. Methods: A randomized experimental design was adopted. A total of 209 students from three nursing assistant training centers in Taiwan were recruited through convenience sampling and randomly assigned to either immersive virtual reality (IVR) or Desktop VR groups for nasogastric tube feeding training. Data were collected through structured questionnaires and analyzed using partial least squares structural equation modeling (PLS-SEM). Results: The results revealed that immersion, curiosity, and control significantly impacted presence, which, in turn, positively influenced the flow state (β = 0.81, p < 0.001). Flow demonstrated positive effects on intrinsic motivation (β = 0.739, p < 0.001), situational interest (β = 0.742, p < 0.001), and self-efficacy (β = 0.658, p < 0.001) while negatively affecting extraneous cognitive load (β = −0.54, p < 0.001). Multigroup analysis showed that IVR had a stronger control–presence effect (|diff| = 0.337, p = 0.016), and flow had a great effect on motivation (|diff| = 0.251, p = 0.01), interest (|diff| = 0.174, p = 0.035), and self-efficacy (|diff| = 0.248, p = 0.015). Desktop VR more effectively reduced cognitive load (|diff| = 0.217, p = 0.041). Conclusions: These findings provide theoretical insights into the role of flow in VR learning and practical guidance for implementing VR technology in nursing education. Full article

Access to healthcare services in rural areas of Peru remains a challenge, with marked differences compared to urban areas. Despite the importance of primary healthcare (PHC) in these communities, the rural population has a negative perception of the role of nursing staff. This study aimed to assess the perceptions of residents in the highland communities of Huata and Ichu, Province of Puno, located in southern Peru, regarding the role of nursing professionals. The general perception of the residents was first analyzed, followed by an evaluation of two dimensions (Fieldwork and Health Education), which allowed for the development of the REFCO (Role of the Nursing professional in the community) scale. The sample included 329 rural adults, mainly between 30 and 59, predominantly female, with incomplete secondary education. The results showed an unfavorable perception (54%) of nursing staff performance. The fieldwork dimension reported low visibility of nursing activities in the community, such as home visits and health programs. The second dimension demonstrated that educational interventions were perceived as infrequent and of low impact, with insufficient adaptation to local needs. These results highlight the need to strengthen the presence and educational strategies of nursing staff in alignment with the cultural and demographic realities of rural communities. Furthermore, it suggests a greater need for interinstitutional collaboration and a more personalized approach to community activities to improve the perception and effectiveness of healthcare services in these areas. Full article

Previous studies suggest that nursing diagnoses (NDs) could predict clinical outcomes, such as mortality, among patients with non-communicable diseases. However, evidence in patients with COVID-19 is still scarce. Objective: To evaluate the association between NDs and COVID-19 mortality among hospitalized patients. Methods: A retrospective cohort study was conducted on 498 paper clinical records of patients hospitalized for at least 72 h in the internal medicine unit for COVID-19 from June to December 2020. The interest association was assessed using logistic regression models. Results: NDs focused on COVID-19 pulmonary responses, such as impaired gas exchange (OR = 3.04; 95% CI = 1.87, 4.95), impaired spontaneous ventilation (OR = 3.67; 95% CI = 2.17, 6.21), or ineffective airway clearance (OR = 2.47; 95% CI = 1.48, 4.12), were significant predictors of mortality. NDs on COVID-19 extrapulmonary responses, such as risk for unstable blood glucose level (OR = 2.45; 95% CI = 1.45, 4,15), risk for impaired liver function (OR = 2.02; 95% CI = 1.11, 3.63), hyperthermia (OR = 2.08; 95% CI = 1.29, 3.35), decreased cardiac output (OR = 2.95; 95% CI = 1.42, 6.11), or risk for shock (OR = 3.03; 95% CI = 1.28, 7.13), were associated with a higher risk of in-hospital mortality. Conversely, patients with NDs of fear (OR = 0.56; 95% CI = 0.35, 0.89) and anxiety (OR = 0.44; 95% CI = 0.26, 0.77) had a lower risk of death. Conclusions: NDs on pulmonary and extrapulmonary responses to COVID-19 were associated with in-hospital mortality, suggesting that they are indicators of the severity of these patients. Therefore, NDs may help nursing staff identify individuals who require closer monitoring and guide early interventions for their recovery. Full article

Background/Objectives: Malnutrition among older adults remains a significant healthcare issue, yet existing questionnaires primarily measure knowledge and attitudes rather than actual behaviors. This study aimed to develop the Nursing Nutritional Care Behaviors Scale (B-NNC Scale) in its original Italian version, translate it into German, and evaluate its psychometric properties in registered nurses and nurse assistants in Austria. Methods: This study followed a two-phase, multi-method design. In Phase 1 (Development Phase), the scale was developed in Italian through a scoping review, expert focus group, and content validation involving 18 clinical nutrition experts using the Content Validity Ratio (CVR). In Phase 2 (Validation Phase), the scale was translated into German through a cross-cultural adaptation process, pilot-tested, and psychometrically validated in a sample of 1072 nurses and nurse assistants working in Austrian hospitals across various clinical settings. Exploratory and confirmatory factor analyses (EFA and CFA) were performed to assess construct validity, measurement invariance between professional roles was tested, and internal consistency was measured using McDonald’s Omega. Results: Content validity was confirmed with a mean CVR of 0.634. EFA suggested a three-factor solution—(1) Nutritional Assessment and Calculation Skills, (2) Nutritional Evaluation and Care Planning, and (3) Nutritional Support and Care Implementation—leading to the retention of 19 items. CFA supported this structure, and McDonald’s Omega indicated high internal consistency across subgroups. Partial measurement invariance revealed some differences in response patterns between registered nurses and nurse assistants. Conclusions: The B-NNC Scale demonstrated robust validity and reliability in measuring self-reported nursing behaviors related to nutritional care in older adults. It addresses a notable gap in existing instruments and may serve as a valuable tool for research and practice to improve malnutrition management. Full article

Background/Objectives: Prior studies have shown that most students seeking entry into a nursing program (also known as pre-nursing students) do not make it into the nursing profession, mostly due to failing one or more science courses in their first year of college. These students give up on nursing, dropping out of college or changing to a less challenging major. Objectives: We aimed to determine the effect of a living learning community (LLC) on the retention and success of students seeking entry into a Baccalaureate Science Nursing (BSN) program. Methods: The aim of this descriptive, prospective cohort project was to improve student retention and success by creating a living–learning community (LLC) for first-year students preparing to apply to a BSN program. The effectiveness of this intervention was determined by comparing retention and success for those in the LLC with those who were not in the LLC over a period of 4 years. Results: Fewer students in the LLC dropped out of or failed college (21% vs. 33%), fewer changed majors (24% vs. 27%), and more were ultimately admitted to the BSN program (42% vs. 36%) during their 3rd year of college. Of those not admitted within the study’s timeframe, there were more students still preparing to apply to a BSN program than those not in the LLC (13% vs. 3%). Regarding minority outcomes, fewer LLC underrepresented minority (URM) students dropped out of college or failed (29% vs. 43%), but more of them changed majors and remained in college, working towards a college degree in another field of study (43% vs. 29%). There was no apparent effect of participation in the LLC program on minority student nursing program admission success. An equal percentage (29%) of minority students from the LLC group and the non-LLC group were admitted to the BSN program during this study. Conclusions: The limitations affecting this study include the prohibition of large face-to-face gatherings during the initial part of this study and the lingering effects of the pandemic and infection control efforts on student learning outcomes. As reported in prior research, first-year nursing students have a high risk of failing or dropping out of college. However, the students who were able to participate in the LLC demonstrated better student outcomes than those who did not, resulting in more students who were able to move towards their goal of becoming a nurse. Full article

Background and purpose: When a family becomes aware of family symptoms, family resilience is defined as its power to autonomously and actively improve its own family functions. A quantitative assessment of family resilience is essential in the practice of family nursing. The purpose of this study was to develop a self-assessment scale for family resilience based on the theoretical foundation of the Concentric Sphere Family Environment Theory (CSFET), and to examine the scale’s reliability and validity. Methods: Based on 23 categories obtained from previous studies clarifying family conditions demonstrating family resilience, the Assessment Scale for Insufficiencies in Family Resilience (IFR), consisting of 21 items, was developed through content validity examinations by an expert committee and through face validity examinations for family members. The reliability and validity of the IFR were examined for families with children or with family members requiring care. Results: Temporal stability over a 2-week interval, which was assessed in 26 subjects, was supported by a high and significant correlation coefficient. The following statistical analysis was performed based on the responses of 206 subjects. The Cronbach’s alpha coefficient showed high internal consistency reliability. The total IFR score showed a moderately significant correlation with the family function score and the family support demands score, demonstrating acceptable criterion-related validity. Exploratory factor analysis confirmed the fit of a five-factor model based on the five systems of CSFET, and construct validity was supported. Conclusions: The reliability and validity of the IFR, which is composed of five factors and 21 items based on the CSFET, were confirmed, making the IFR a viable self-assessment scale for determining the level of family resilience. Full article

Background: Musculoskeletal problems contribute to nurse attrition, which compromises patient safety and costs healthcare organizations millions of dollars. Recent research describes a physical activity paradox in which high amounts of work-related physical activity may be detrimental to health; however, there is a lack of evidence on the physical activity paradox with respect to musculoskeletal health in nurses. The purpose of this study was to examine the relationship between musculoskeletal symptoms (MSSs) and high amounts of physical activity at work in nurses. Methods: This was a 7-day observational design using direct measurement of physical activity and self-reported MSSs in nurses. Physical activity was measured in step counts using a wearable accelerometer and MSSs were reported using ecological momentary assessment. Step counts and MSSs were compared between work days and days off, and a regression model analyzed the combined effect of physical activity and work days on MSSs while controlling for age, exercise, and body mass index. Results: Musculoskeletal symptoms and step counts were significantly higher on work days compared to days off. Higher step counts on work days resulted in significantly higher expected MSS ratings than the same number of steps taken on a day off. Conclusions: This study supports the existence of a physical activity paradox in nurses with respect to MSSs. Understanding this paradox in the nursing workforce can translate to interventions that reduce the detrimental health effects of high levels of physical activity at work, which can minimize nurse attrition, improve patient outcomes, and reduce costs in healthcare organizations. Full article

Background: The frequency of propensity score matching (PSM) use in research is exponentially increasing; however, its use in nursing has not yet been explored and is possibly underused. Methods: Synthetic knowledge synthesis has been used on two corpora of publications from the Web of Science bibliographic database for the following purposes: first, to identify the content of the current nursing PSM studies; second, to identify the content of nursing observational, retrospective, or other quasi-experimental studies; and finally, based on the above analyses, to explore new possibilities for further use of PSM in nursing. Findings: The use of PSM in nursing is very sparse, but the number and content of observational, retrospective, and similar nursing research is increasing and becoming more extensive. Ten prolific themes in observational nursing studies were identified. Based on these studies, several influential studies in which PSM has already been successfully used in comparable healthcare topics have been selected as opportunities for extended PSM use in nursing. Conclusions: As shown in the healthcare disciplines, the extended use of PSM in nursing research might make nursing research more consistent, relevant, internally and externally valid, and consequently more useful in clinical practice and research. Full article

To effectively mitigate the health impacts of climate change, future nurses must be equipped with the requisite knowledge and competencies. Knowing their levels of eco-literacy would help to make them more effective. Background/Objectives: This descriptive study will use a three-round, multicentre, modified e-Delphi survey to establish an expert panel’s consensus on the Climate, Health, and Nursing Tool’s (CHANT) item-level and scale-level content validity indices. It will also examine potential associations between the expert panel members’ sociodemographic and professional characteristics and their content validity index assessments of the CHANT. Methods: The study will be conducted in the French-speaking regions of Switzerland, running its three-round e-Delphi survey between January and April 2025. After each round, the CHANT’s overall scale-level and individual item-level content validity indices will be computed. Comparisons between different types of healthcare professionals’ profiles will also be conducted. Results: The three-round modified e-Delphi survey should allow the expert panel to reach a consensus on the CHANT’s overall content validity index. The tool should then be considered suitable for pilot testing. The first round brought together 16 experts from different regions, namely French-speaking Switzerland, France, and Belgium. Conclusions: To ensure that the nursing discipline is well positioned to meet future challenges, the development of eco-literacy must be integrated into nursing education. Ensuring the CHANT’s conceptual and psychometric validity will be essential in strengthening nursing competencies in and knowledge about planetary health and in implementing future educational interventions. Full article

Background: Person-centered care (PCC) approaches are widely recognized for improving the quality of life of residents living with dementia in long-term care (LTC). However, residents are only one part of the care dyad, and it remains unclear whether PCC also impacts nursing care aides in similarly adventitious ways. Care aides in this context experience significant care strain, which refers to the physical, emotional, and psychological burden experienced by caregivers. While PCC approaches are promoted as the best approach for supporting residents living with dementia, there is limited research on whether their implementation also impacts care aides. This study examined potential associations between organization-level PCC indicators and care strain among nursing care aides who work with residents living with dementia in LTC homes in New Brunswick, Canada. Methods: A cross-sectional survey design was used to explore the relationship between PCC approaches and care strain. Care strain was measured using the strain in dementia care scale, including the daily emotions subscale. A modified version of the Dementia Policy Questionnaire assessed the extent to which PCC approaches were implemented in participants’ workplaces. Descriptive statistics characterized the sample, and multivariable regression analyses examined associations between PCC indicators and care strain, adjusting for demographic factors. Results: Twenty-eight participants completed both measures. Overall, participants reported high levels of care strain but also high levels of positive daily emotions. Findings partially supported the hypothesis that PCC indicators were associated with lower care strain and more positive daily emotions. Certain PCC indicators, such as structured education and ethical support, appeared particularly beneficial. Implications for Practice: Strengthening PCC practices—especially through hands-on training and ethical support—may help reduce care strain and enhance care aides’ emotional well-being. LTC facilities that prioritize these strategies over policy implementation alone may improve both staff well-being and quality of care for residents. Full article

Background/Objectives: Self-care strategies enhance well-being and facilitate coping with emotional distress, particularly for palliative care professionals dealing with end-of-life issues. This study aimed to explore self-care practices among healthcare professionals working in palliative care settings by analyzing their perceptions and reflections. Methods: A total of 36 palliative care professionals participated in one of four focus group discussions on the topic of self-care. The discussions were transcribed and analyzed using qualitative content analysis. Results: Participants identified several self-care strategies as the most effective and the most frequently used, including lifestyle and emotional coping techniques. The meaning of self-care and its functions were delineated. Participants also identified factors that either facilitate or hinder self-care and discussed its impact on team well-being. Not all participants had received professional self-care training, and some struggled to identify their own strategies. However, participation in the focus group discussions was perceived as beneficial for improving work dynamics, group cohesion, communication, and freedom of expression. Conclusions: The positive feedback from the focus groups suggests that they are a valuable tool for fostering further discussions on self-care. The study recommends increasing the implementation of self-care strategies and professional training to enhance the well-being of palliative care professionals, their teams, and the patients they care for. Full article

Background: Nursing students must be able to enter clinical practice as safe, accurate, competent, and compassionate professionals. Objectives: The aim of this study was to investigate the effectiveness of simulation training on the satisfaction and self-confidence of undergraduate nursing students. Methods: A cross-sectional and correlational study was conducted among 151 students enrolled in the third semester of nursing. Data were collected using a questionnaire comprising three instruments: SSSCL, SDS, and EPQ. Pearson’s correlation analysis was used to examine the relationship between satisfaction and self-confidence. Multiple linear regression was conducted to assess the influence of simulation design and various educational practices on students’ satisfaction and self-confidence. Results: The results revealed high mean scores for satisfaction (4.41 ± 0.40) and self-confidence (4.50 ± 0.36). A moderate, significant positive correlation was found between self-confidence and satisfaction (r = 0.579, p < 0.001). Furthermore, various learning methods (B = 0.112, p = 0.037, 95% CI [0.007; 0.217]) and objectives/information clarity (B = 0.175, p = 0.040, 95% CI [0.008; 0.342]) had a significant positive effect on satisfaction. Similarly, active learning (B = 0.146, p = 0.020, 95% CI [0.023; 0.268]) and feedback (B = 0.154, p = 0.035, 95% CI [0.011; 0.297]) had a significant positive effect on self-confidence. Conclusions: This study confirms that simulation-based training effectively boosts nursing students’ satisfaction and self-confidence, supporting its integration as a key component of nursing education to better prepare them for clinical challenges. Full article

Background: Nursing Schools are incorporating Mixed Reality (MR) into student training to enable them to confront challenging or infrequently encountered scenarios in their practice and ensure their preparedness. This systematic review evaluates the benefits and challenges of implementing MR in nursing curricula. Materials and Methods: A search was conducted in PubMed, WOS, Scopus, Embase, and CINAHL for studies published between 2011 and 2023. The search strategy used was “(nurses OR nurse OR nursing) AND mixed reality AND simulation”. Inclusion criteria required that studies focus on undergraduate nursing students and be written in English or Spanish. Exclusion criteria included reviews, bibliometric studies, and articles that did not separately report undergraduate nursing student results. Quality was evaluated with the JBI Critical Appraisal Checklist for Qualitative Research and the Newcastle-Ottawa Scale. A meta-analysis was conducted on studies with control groups to compare MR’s effectiveness against traditional teaching methods. Results: Thirty-three studies met the inclusion criteria. MR was widely used to improve clinical judgment, patient safety, technical skill acquisition, and student confidence. The meta-analysis found that MR reduced anxiety (Cohen’s d = −0.73, p < 0.001). However, its impact on knowledge acquisition and skill development was inconsistent. There was no improvement over traditional methods (p = 0.466 and p = 0.840). Despite positive qualitative findings, methodological variability, small sample sizes, and publication bias contributed to mixed quantitative results. The main challenges were cybersickness, usability, high costs, and limited institutional access to MR technology. Conclusions: Although MR can help nursing education by decreasing students’ anxiety, its efficacy remains inconclusive. Future research should use larger, randomized controlled trials to validate MR’s role in nursing education. Full article

This paper presents a newly developed online learning program currently designed to meet the learning objectives of nurses and midwives and rare and undiagnosed disease. Background/Objectives: This paper will also introduce the Global Nursing Network for Rare Disease and its role and commitment in supporting nurses and midwives in the identification of rare disease and the delivery of appropriate care and interventions to care for people living with rare and undiagnosed disease. Globally, nurses and midwives are often the first healthcare provider a patient will engage with. Combined with the estimated 300 million living with a rare disease across the globe, nurses and midwives are well positioned when assessing patients to have adequate awareness and suspicion to consider the presence and impact of rare disease. To enable this awareness and knowledge to ensure timely assessment and referrals, specific knowledge is required. There is a current paucity of learning programs about rare and undiagnosed disease specifically for nurses and midwives. Methods: The proposed learning program comprises seven modules designed to address the learning needs of novice to expert nurses and midwives from across the globe. Increased knowledge will in turn increase awareness and confidence to inform decision-making for patients presenting with undiagnosed signs and symptoms by ‘thinking rare’. Results: The proposed learning program comprises seven modules and a number of individual lessons which will be suitable for the needs of novice to expert nurses and midwives from across the globe. Full article