Nurs. Rep., Volume 15, Issue 5 (May 2025) – 45 articles

Background: Resilience is a cornerstone attribute for nursing students, enabling them to adapt to stressful situations encountered during their educational journey and subsequent healthcare career. Objective: This qualitative study aimed to explore nursing instructors’ experiences promoting resilience among nursing students during clinical education. Methods: Focus groups were conducted with 27 instructors from four nursing colleges in Thailand. Data were analyzed using Braun and Clarke’s inductive thematic analysis approach, guided by the Unitary Caring Science Resilience-Building Model. Results: Two main themes emerged: (1) Challenges to Nursing Students’ Resilience and (2) Support Strategies for Enhancing Resilience. Challenges included bridging theory and practice, upholding confidence in clinical skills, adapting to new clinical environments, and managing expectations. Support strategies encompassed providing comprehensive preparation, fostering open communication, implementing peer support systems, and utilizing reflective practice. Conclusions: The findings highlight the complex interplay of factors affecting nursing students’ resilience and the multifaceted approaches instructors use to support it. This study underscores the need for a holistic approach to nursing education that addresses clinical competence and psychological well-being. Implications include curriculum redesign to bridge the theory–practice gap, enhanced instructor training in mentorship and resilience-building, implementation of comprehensive student support systems, and technology integration to support learning and resilience. Full article

Background/Objectives: Peristomal skin complications (PSCs) are common among patients with ostomies, significantly impacting quality of life and increasing healthcare utilization. This study aimed to evaluate the effects of the Dermamecum protocol, a risk-stratified educational intervention, on the prevention of PSCs, self-care improvements, health-related quality of life (HRQoL), and patient satisfaction over a 90-day follow-up period. Methods: This prospective cohort study included 305 patients stratified into three risk-based groups (green, yellow, and red paths) according to the Dermamecum protocol. Primary outcomes included PSC rates at 30, 60, and 90 days. Secondary outcomes included self-care scores, HRQoL, and patient satisfaction. Comparative analyses and trend assessments were performed across groups and time points. Temporal trends in PSCs were analyzed using Poisson regression. Results: Early PSC rates were 8.5% at 30 days, with late complications at 7.9% and 6.2% at 60 and 90 days, respectively. No significant differences in PSC rates were observed between paths. Self-care scores improved over time, with stability across groups and domains. HRQoL remained stable, with minor fluctuations in physical and mental components. Patient satisfaction was high across all paths. Poisson regression identified significant temporal trends in PSC rates, with higher risks at 30, 60, and 90 days compared to baseline. Age, BMI, and path assignment (lower risk for the green path) were significant predictors of PSCs. Conclusions: The Dermamecum protocol effectively maintained low PSC rates, supported self-care, and sustained HRQoL and patient satisfaction. These findings highlight the value of risk-stratified, patient-centered interventions in ostomy care. Further studies are needed to validate these results and explore long-term outcomes. Full article

Background/Objectives: The REACtion project was developed to provide nursing care to older adults at home within the primary care setting. The COVID-19 pandemic posed significant challenges to its implementation, acting both as a barrier and an opportunity. Although several studies have explored healthcare innovation during emergencies, there remains a need for strategic insights to guide real-world implementation efforts. This study aims to explore how the COVID-19 pandemic influenced the implementation of the REACtion project and identify the strategies adopted to ensure continuity and effectiveness in achieving its goals despite the challenges posed by the health emergency. Methods: A qualitative descriptive study was conducted. Semi-structured interviews were carried out with nine project stakeholders, including nurses and researchers, between April and May 2023. The interviews were transcribed verbatim, read in-depth, and analyzed using content analysis to identify perceived barriers, facilitators, and strategies adopted during the project. Results: The pandemic shifted priorities from routine care to emergency health activities. Barriers to project implementation included social distancing, disruptions in the decision-making processes, and a general decline in community welfare. Despite these obstacles, the COVID-19 context underscored the central role of Family and Community Nurses in proactive primary care. Stakeholders adopted relationship-based strategies, addressed workforce shortages, and implemented measures to mitigate personal fatigue. Conclusions: The implementation of innovative nursing interventions during emergencies requires adaptability, collaboration, and context-sensitive approaches. Strengthening stakeholder engagement and leveraging professional roles within the community are essential to overcoming barriers and seizing opportunities in crisis contexts. Full article

Background: Vascular access in emergency departments (ED) is challenging for patients with difficult venous access (DIVA), causing delays and discomfort. Ultrasound-guided techniques may offer improved outcomes, making it crucial to assess their benefits, risks, and the effectiveness of validated identification systems. Objectives: To contribute new evidence regarding the effectiveness of validated tools for identifying DIVA and to assess the clinical benefits of ultrasound-guided vascular access in emergency care, and to assess their utility in arterial puncture for arterial blood gas sampling, from now on ABG, within the ED. Methods: This study follows the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidelines for protocol development and the Consolidated Standards of Reporting Trials (CONSORT) guidelines for the conduct and reporting of the randomized clinical trial (RCT). The trial will be conducted in Spain throughout 2025. The study population will consist of 114 subjects with difficult intravenous access (DIVA), identified using the DIVA scale for individuals under 14 years of age and the A-DICAVE scale for adults, along with 80 subjects from the general surgical area (GSA). Participants will be randomly assigned, in a 1:1 ratio, to either the Control Group (CG) (traditional technique) or the Experimental Group (EG) (ultrasound-guided technique). Data collected will include sociodemographic characteristics, procedure-related variables (e.g., time required, human resources, and materials used), as well as pain levels, assessed using validated scales (EVA, FLACC, PAINAD), and overall satisfaction from both patients and healthcare professionals. Ethical approval has been obtained, and the trial will be registered as an RCT through an official clinical trial registry before recruitment begins. Results: Expected results suggest ultrasound guidance will significantly improve first-attempt success rates, reduce procedural time, enhance patient comfort, and optimize resource utilization compared to traditional techniques. Conclusions: The integration of ultrasound-guided vascular access into routine emergency protocols could enhance patient safety, satisfaction, and procedural efficiency in emergency care settings. Full article

Background/Objectives: Home non-invasive ventilation use is the primary treatment for improving respiratory function in people with chronic hypercapnic respiratory failure. Non-invasive ventilation has also been studied to understand users’ perspectives. However, no studies have been conducted on how users adapt to non-invasive ventilation in their homes from the early phase of their diagnosis as a long-term utility. Methods: The study employed a descriptive qualitative design guided by Roy’s adaptation model. A purposive sample was used. People with chronic hypercapnic respiratory failure who had used NIV at home for a minimum of six months would be eligible. They were interviewed at a sleep and assisted ventilation centre. Their interviews were audio recorded before proceeding with transcription. Each transcript was thematically analysed. Results: Twenty participants were included in the study, from which six themes emerged. They experienced a common transition, from denying the need for non-invasive ventilation to integrating them into their daily lives at home. Throughout this process, they had emotional turmoil, faced difficulties in keeping their masks on, and improved sleep quality. They also adjusted their social interactions before fully accepting the use of non-invasive ventilation. Their coping strategies in their role functions at home and social interaction were also narrated. Their family members were pivotal in their adaptation period. Conclusions: Gaining insight into individuals’ adaptation experiences can facilitate early identification of potential challenges faced by new users of non-invasive ventilation. This study calls for healthcare professionals to assess users’ understanding of long-term commitment and their living conditions early for a successful NIV adaptation. Full article

Background: Critical thinking is fundamental for registered nurses (RNs) when making clinical decisions, which impact patient outcomes. This review aimed to identify studies on critical thinking and clinical decision making among nurses in clinical practice and synthesize their findings based on the regional area, observed findings, and predictive factors, and to assess the measurement tools used. Methods: A comprehensive search of the PubMed, Web of Science, CINAHL, and SCOPUS databases up to December 2024 was conducted in accordance with the PRISMA guidelines. The Newcastle–Ottawa Scale was used to assess the quality of included studies. Studies with similarly themed components were grouped for narrative synthesis. A meta-analysis of random-effects model calculations was performed. Results: This review included forty studies (twenty-four on CT, twelve on CDM, four on both) from various WHO regions, revealing diverse findings on observed skills. Ten CT and four CDM measurement tools were identified. Many studies also explored individual and group-level predictive factors for these skills. Meta-analyses of four common tools (CCTDI, NCT4P, CDMNS, and NDMI) showed significant heterogeneity, with statistically significant pooled mean scores. Conclusions: The synthesis highlights the global research on nurses’ critical thinking and clinical decision making, including the exploration of various predictive factors. However, the significant heterogeneity in the findings from meta-analyses of commonly used measurement tools underscores a need for more standardized measurement and analytical approaches, such as multilevel modeling, to better account for the hierarchical nature of potential predictive factors (individual and group levels), which would allow for more reliable comparisons and stronger conclusions in this field. Full article

Background/Objectives: Academic engagement (AE) and work engagement (WE) are important indicators of performance and well-being in educational and occupational settings. Although these constructs are well researched independently, few studies have examined them concurrently among individuals navigating both academic and professional demands. Nursing students who are simultaneously employed as nurses represent a unique and under-researched population in this context. Understanding how personality traits influence both AE and WE in this dual-role group may offer insights relevant for academic success and well-being in healthcare settings. Methods: The sample consisted of 230 nursing students from a public university in Croatia who were also working as nurses. This study employed a repeated cross-sectional descriptive predictive research design (2022–2025). The participants completed questionnaires (UWES-9, UWES-S-9, and IPIP-15) during their university lectures. Results: The analysis yielded two personality clusters (adaptive—lower levels of neuroticism and higher levels of the other personality traits and maladaptive—the opposite). The participants in the adaptive cluster had higher levels of WE and AE. Regression analysis revealed that conscientiousness was a significant predictor for WE and AE, whereas agreeableness was a significant predictor for only WE. Conclusions: The findings highlight the importance of personality traits when addressing AE and WE, and fostering traits such as conscientiousness and agreeableness may enhance positive work and academic outcomes. Personality traits showed similar patterns of association with both AE and WE, indicating that dispositional factors may play a more crucial role in WE and AE than external influences. Full article

Background and Objectives: Medication errors are a critical issue in healthcare systems worldwide, contributing to significant patient harm, with studies indicating that medication-related incidents are among the most common causes of adverse events in medical practice. There are between 80 and 200 steps in providing a single patient with a single dose of drugs, with five stages, including prescription, preparation, dispensation, administration and monitoring. This study aims to describe and validate the MAEs (Medication Administration Error Scale) tool, which investigates the most common causes of medication errors in medication administration. Materials and Methods: Independent translators translated the original version of the scale using language verification. The agreed-upon version of the translation was then assessed by a team of nurses, specialists in anaesthetic and intensive care nursing, in terms of understanding the translated content. After introducing changes resulting from linguistic and organisational differences, a survey questionnaire was prepared and used in the pilot study. Eighty-six respondents participated in the pilot study via the Office 365 platform and the Forms programme. The research was led by nurses who work in highly specialised units. The reliability of the translated version of the questionnaire was examined by calculating the Cronbach’s alpha coefficient. Results: The tool’s internal consistency across ranges was within acceptable limits. For part A (questions 1–29), it was 0.93; for part B (questions 30–45), it was 0.94. In part C, regarding the percentages of the type of error occurring in a given medical facility, Cronbach’s alpha coefficient was 0.97. When the factor loadings of the items were evaluated, they were determined to be in the range of 0.602–0.783. In this context, the factor loading levels of the items in the 5-factor model were high and sufficient. Conclusions: The statistical analyses suggest that the Polish version of the Medication Administration Error Survey demonstrates satisfactory reliability and is a promising tool for assessing the cause of medication administration errors. Full article

Background/Objectives: Mental health literacy (MHL) plays a crucial role in transitional processes, influencing, for example, students’ adaptation to higher education and, later, their transition into the workforce. This study assesses MHL about depression among first- and fourth-year nursing students and identifies which MHL components and related variables are associated with a higher likelihood of being in either academic year. Methods: A cross-sectional descriptive correlational study was conducted with 478 nursing students (59.4% first-year students; 40.6% fourth-year students), predominantly female (82.2%), with a mean age of 20.41 years (SD = 4.71) and a median age of 19.0 years. Results: The results revealed a low level of recognition of depression and knowledge of mental health first aid (MHFA) strategies, including health literacy. Students tended not to hold beliefs based on myths and stereotypes about mental illness and individuals with mental illness and did not have highly stigmatizing views. MHL varied by year of study, with fourth-year students having more adequate MHL levels. Conclusions: These findings highlight the need to integrate MHL as a key element of academic success. Health education initiatives that promote mental health, prevention, and MHFA training may serve as effective strategies to enhance MHL among nursing students. Full article

Background: The healthcare sector is under increasing pressure due to an ageing population, rising multimorbidity, and a projected global workforce shortage of 10 million by 2030. It is becoming increasingly apparent that addressing these challenges requires more than simply increasing workforce numbers—it necessitates a shift towards innovative practices in healthcare education. Higher education (HE) plays a crucial role in preparing future healthcare professionals, yet embedding innovation within HE presents challenges such as resistance to change, resource limitations, and difficulties in interdisciplinary collaboration. This review explores the barriers and opportunities associated with fostering innovation in HE health programmes. Methods: This narrative review explored the recent literature on innovation in healthcare HE, examining national policies, institutional strategies, and emerging technological advancements. It describes the impact of digital learning tools, simulation-based education, artificial intelligence (AI), and interprofessional education (IPE) on student learning outcomes and workforce preparedness. Results: Findings suggest that while digitalisation and AI-driven innovations offer opportunities to enhance HE health programmes, their effectiveness is dependent on appropriate pedagogical integration and resource. Challenges include upskilling workforce to new more modern methods, ensuring equitable access to digital resources, and maintaining a balance between technological innovation and traditional face-to-face learning. Conclusions: To embed innovation effectively within healthcare HE, institutions may need to prioritise interdisciplinary collaboration, entrepreneurial thinking, and sustainable funding models. While technology is key to modernising education, it should be implemented alongside evidence-based pedagogical strategies to ensure meaningful learning outcomes and long-term workforce preparedness. Full article

Background/Objective: Needlestick injuries (NSIs) are a significant source of bloodborne infections among nurses. This study aimed to assess the prevalence, contributing factors, and awareness of post-exposure prophylaxis (PEP) among Estonian nurses. Methods: This prospective cross-sectional study was conducted using an electronic questionnaire in September 2024. Results: The majority of the 211 nurses participating in this study were females aged 21 to 75 years. Notably, 57.1% (n = 109, aged 43.9 ± 12.2) had experienced an NSI in the past decade. Most injuries occurred during sharps’ disposal (33%) and with syringe needles (72%). Among those injured, 84% washed the area with water and soap, 80% used alcohol-based disinfectants, and 69% reported the incident. However, 20.6% did not report due to perceived insignificance or lack of follow-up actions. Additionally, 14.7% were unaware of the reporting requirement, and 8.8% did not know who to report to. Conclusions: Improved training and reporting practices are essential to reduce NSIs among nurses. Full article

Background: Weight bias in healthcare can affect the quality of care and create health disparities. In nursing, the presence of weight-biassed attitudes influences the therapeutic relationship and clinical decision-making. However, in Spain, research on this phenomenon remains scarce, hindering the development of strategies to mitigate its impact. Objectives: This study aimed to assess the methodological feasibility of a study on weight bias in nursing, and to explore nurses’ attitudes towards being overweight and obesity and their association with sociodemographic and body image variables. Methods: A cross-sectional, quantitative pilot study was conducted with 22 primary care nurses. The Anti-Fat Attitudes (AFA) and Beliefs About Obese Persons (BAOP) scales, previously validated in Spanish-speaking populations, were applied. Response distribution, the internal consistency of the instruments, and the relationship between variables were analysed. Results: Difficulties were identified in the recruitment of participants and the reliability of certain items of the questionnaire, as well as in the internal consistency of the scales. A trend towards moderate weight-biassed attitudes was observed in the sample, with the highest scores in the AFA’s “Willpower” subscale. The BAOP scale showed a significant negative correlation with the AFA (r = −0.55, p = 0.009), indicating that a lower attribution of obesity to individual control is associated with less discriminatory attitudes. Conclusions: This pilot study helped identify methodological improvements and confirmed the presence of weight bias in nursing. It is recommended that the sample be expanded and the measuring instruments refined before performing the full study. Full article

Objective: To explore the feasibility and acceptability of using an evidence-based Tai Chi intervention to manage the fatigue–sleep disturbance–depression symptom cluster (FSDSC) in female breast cancer patients. Methods: This study reported the feasibility outcomes of a pilot randomized controlled trial (RCT), along with a nested qualitative process evaluation. Seventy-two female breast cancer patients experiencing the FSDSC were randomized into either a Tai Chi group or a control group. The Tai Chi group received an eight-week Tai Chi intervention consisting of two one-hour sessions per week, along with routine care, while the control group received routine care only. The feasibility and acceptability of the study procedure and Tai Chi intervention protocol were assessed by measuring recruitment, referral, retention and drop-out rates, questionnaire completion rates (including the Brief Fatigue Inventory [BFI], Pittsburgh Sleep Quality Index [PSQI], Hospital Anxiety and Depression Scale-Depression [HADS-D], and Functional Assessment of Cancer Therapy-Breast [FACT-B]), intervention adherence, and safety outcomes. The nested qualitative process evaluation consisted of semi-structured interviews conducted among 22 participants to further explore their experiences of participating in this study and practicing Tai Chi. Descriptive data analysis was employed to present the feasibility and acceptability outcomes. Content analysis was employed to analyze the data from the qualitative process evaluation. Results: A total of 72 breast cancer patients were successfully recruited over six months, with a recruitment rate of 79.1%, retention rate of 95.8%, and dropout rate of 4.2%. No missing data was found in the BFI, PSQI, or HADS-D. However, a notable number of missing values were found in the FACT-B, particularly for items related to sexual satisfaction. The Tai Chi intervention demonstrated a high level of feasibility, with an average adherence rate of 86.8%. Only eight participants reported minor discomforts, such as minor musculoskeletal discomfort and dizziness, but they were transient and manageable after stopping Tai Chi practice. Semi-structured interviews with 22 participants highlighted that Tai Chi was experienced to be generally convenient, energy-saving, and low intensity for FSDSC management. Participants also felt that the study questionnaires were comprehensible and straightforward. Many interviewees from the Tai Chi group reported perceiving favorable effects on FSDSC management, as well as overall functional health and well-being. Conclusions: The evidence-based Tai Chi intervention proved feasible, safe, and convenient as a non-pharmacological intervention for managing FSDSC in breast cancer patients. Future large-scale studies are needed to evaluate Tai Chi’s definite effects on improving FSDSC among breast cancer patients. Full article

Background/Objectives: Lower-limb amputation profoundly affects individuals and their family caregivers, particularly during home transition after hospital discharge. Understanding the needs, challenges, and emotions during this period is essential for designing effective family centered empowerment interventions. This study aimed to explore the lived experiences of amputees and their caregivers, identify their needs and challenges, and identify strategies to foster empowerment, resilience, and adaptation after amputation. Methods: This qualitative, descriptive-exploratory study involved semi-structured interviews with 37 dyads, each comprising an amputee who has undergone major dysvascular lower-limb amputation and their primary caregiver, who provided home care. The participants attended follow-up consultations post-amputation. Data were collected over a 13-month period and analyzed using qualitative content analysis based on Bardin’s methodology, with support from ATLAS.ti 23.3.4 software for coding and data organization. Results: Four categories emerged: (i) difficulties faced, including loss of autonomy, mobility challenges, architectural barriers, and emotional strain; (ii) home discharge, emphasizing functional training for amputees and caregivers and the need for community support; (iii) impact of amputation, highlighting acceptance difficulties, psychological distress, social isolation, and lifestyle changes; and (iv) empowerment strategies, focusing on psychological support, skills training, assistive devices, and coordinated care. Tailored interventions such as peer support, home adaptations, and multidisciplinary care are essential for resilience, independence, and improved quality of life. Conclusions: Family centered empowerment strategies are vital for improving the outcomes of amputees and caregivers. Interventions that prioritize caregiver education, psychological support, and enhanced accessibility promote resilience, autonomy, and quality of life. These findings highlight the need for integrated hospital-to-community programs. Full article

Background/Objective: Part of the workload of ambulance service involves patients with low-acuity health events that do not require the specific resources provided by ambulance services or emergency departments (EDs). The problem of inappropriateness is also present in Italy. However, research is limited to the perspective of triage nurses only, excluding patients and emergency medical service (EMS) staff. This study aims to identify the presence of inappropriate ambulance use in the study context by comparing patients’ perception of emergency with appropriateness perspectives of both triage nurses and emergency service staff. Methods: A cross-sectional study involving 109 patients transported by ambulance was performed between January and March 2020. Questionnaires were distributed to patients, EMS staff, and triage nurses operating in the chief town and hinterland of a region of Italy. Results: Non-penetrating trauma was the most frequent cause for calling an ambulance. Patients referred that activation of the service was necessary, while triage nurses and EMS technicians were in line in believing the non-urgency of the call due to non-emergent health conditions. Conclusions: Although we cannot conclude that citizens use the emergency system inappropriately, the results of this study make us think about the need to implement educational interventions that increase citizens’ knowledge of how the service works and the territorial services available. Full article

Background: Research in the intensive care unit (ICU), which involves critically ill patients, families and healthcare professionals, poses significant ethical challenges. The aim of this PRISMA-guided systematic review is to identify major challenges for research ethics in the ICU. Methods: Pubmed and Scopus databases were searched in November-December 2024 for papers discussing theoretical concepts or specific aspects related to ethical issues in ICU research, retaining 70 papers on ICU research challenges, difficulties or controversies. Results: A total of 10 papers described general concepts related to research ethics in the ICU, 16 studies focused on the methodology or some of the study steps, and 6 papers focused on ICU trials, while 38 studies focused on special patient categories or special situations of critical patients. None of the included papers addressed all of the issues we identified regarding the ethical challenges. Conclusions: ICU research is challenging from a moral point of view. Significant ethical difficulties arise during the design and implementation phases, hampering the study's exactness. Being a vulnerable population with limited decision-making capacity and research-associated risks, alternative consent methods need to be considered. This systematic review provides a checklist of aspects that could generate ethical dilemmas and might constitute a starting point in the conduct of research studies, preventing unethical research. Full article

Objective: To synthesize and analyze the prevalence, composition, longitudinal stability, and predictors of cancer symptom clusters in children and adolescents undergoing chemotherapy. Method: A systematic literature review was conducted in accordance with the PRISMA 2020 guidelines. Evidence was sourced from MEDLINE/PubMed, Cochrane Library, Embase, PsycINFO, and Web of Science, as well as clinical trial registries (Clinical Trials WHO-ICTRP) and gray literature. The search was performed in February 2025, with no restrictions on publication date or language. Two independent reviewers screened and selected the studies. The methodological quality of the included studies was assessed using design-specific tools, and the findings were synthesized narratively. Results: A total of 6221 records were identified, with 12 studies meeting the inclusion criteria. These studies were published between 2010 and 2024 in the United States, Brazil, China, and Turkey. Cancer symptom clusters in children and adolescents followed well-defined patterns, with the gastrointestinal, emotional, fatigue-related, somatic, and self-image clusters being the most prevalent. Conclusions: Early identification of these cancer symptom clusters is essential for guiding interprofessional teams in delivering personalized, evidence-based care to children and adolescents with cancer and their families. Full article

Objectives: The objectives of this study were to determine the suitability of the low-fidelity/low-cost simulator “Salvando a Rosita^®” in the acquisition of “hands-only CPR” skills by adult nursing degree students. Methods: A quasi-experimental quantitative study was carried out with a single experimental group that included 89 nursing degree students; it was conducted in November and December 2024 at the National University of Trujillo, Peru. Results: The STAI-TA score was 17.30, and the STAI-SA score was 37.00 points. Women showed a greater level of SA (p = 0.002). The required effort was described by women as being high and by men as light (p < 0.001). The compression rate was 125.7, and the percentage of compressions with an adequate depth was 89.6%. Overweight/obese individuals achieved more correct compressions (p < 0.01). The attitudes toward alerting emergency services, remaining calm while a person is in cardiac arrest, applying the CPR sequence automatically, and performing CCs were better after receiving training. The majority considered the “Salvando a Rosita^®” simulator to be useful for teaching “hands-only CPR” to students in the first cycles of a nursing degree. Conclusions: The “Salvando a Rosita^®” simulator was found to be an appropriate tool for teaching “hands-only CPR” to students in either the first cycles of health sciences or in other related professions. Full article

Background/Objectives: Satisfaction among undergraduate nursing students plays a crucial role in student retention, helping to mitigate nursing shortages in the workforce, reduce academic costs, and uphold universities’ reputations. The Nursing Student Satisfaction Scale (NSSS) measures three theoretical domains: Professional Social Interaction, Curriculum and Teaching, and Learning Environment. Although the NSSS has demonstrated reliability and validity with respect to American nursing students, its psychometric properties have not been tested on a population of Italian nursing students. Therefore, this study aimed to determine the reliability and validity of the NSSS in regard to Italian nursing students. Methods: A multicenter observational study was conducted on undergraduate nursing students in Central Italy. A confirmatory approach was used to assess structural validity. The construct validity, internal consistency, test–retest reliability, and responsiveness to change of the NSSS were evaluated using correlation analyses, reliability coefficients, and measurement error determination. Results: Confirmatory factor analysis supported the three-factor first-order structure of the NSSS as well as the presence of a single second-order factor. Reliability was adequate for all the coefficients computed (with values ranging from 0.924 to 0.974). Construct validity was supported. The measurement error was adequate. Conclusions: The NSSS exhibited robust measurement properties, confirming its validity and reliability as an instrument for assessing nursing student satisfaction in the Italian context. Furthermore, our results indicate that, after the translation and cultural adaptation of the scale, the construct of nursing student satisfaction remains consistent with the theoretical model. Full article

Background: Leadership is present at all levels of nursing and is essential to ensure the continuous improvement of nursing practice environments and the quality of the care provided to patients. This reality, coupled with the growing complexity of today’s health contexts, emphasises the importance of promoting the development of leadership skills in undergraduate nursing students, thus training nurses who are capable of acting as leaders and agents of change. To this end, a scoping review was carried out to map the available scientific evidence on the development of leadership in undergraduate nursing students. Methods: The scoping review was conducted according to two systematic review guidelines. The searches were conducted across a total of five databases for published studies and two databases for the unpublished/grey literature. The data extraction and analysis were performed by two reviewers, who independently screened and extracted data from the selected studies. Results: This review included 25 articles, and four thematic categories were identified—students’ perceptions of leadership; strategies to train leaders in nursing; the evaluation of leadership development; and conceptual models and curricula. The main conclusions highlight the need to reformulate existing curricula, the importance of integrating student-centred pedagogical approaches to promote leadership development, the impact that evaluating leadership development has on the whole process, contributing to the construction of an identity as a leader, and the need for it to be done in a structured and progressive way. Conclusions: The teaching of leadership should be promoted from the beginning of training, in a transversal, continuous, consistent, sustained, and articulated way, incorporating different disciplines, because only in this way will it be possible to train competent nurse leaders who are capable of acting in today’s complex and dynamic health contexts. Full article

Background/Objectives: Although medical radiation practice is essential for current medical care, many nursing students and nurses lack sufficient basic knowledge about radiation, and they are unfamiliar with learning about it. This study aimed to evaluate the usefulness of self-made video teaching materials for radiation education for nursing students and nurses after clarifying their basic knowledge of radiation. Methods: Educational video materials were developed to provide basic radiation knowledge. The video materials included scenes of radiation measurement, such as the attenuation of scattered X-rays with distance, and illustrations drawn by nursing students to make them familiar to nursing staff. This study included 29 nursing students and 16 nurses. The participants were instructed to answer 20 questions regarding the characteristics of radiation and its influence and protection measures. The same questions were asked again after watching the video materials. Results: Nursing students and nurses correctly recognized the classification of medical or occupational exposure and the three principles for reducing external exposure; however, it became clear that dose limits do not apply to medical exposure and that radiation units and their effects on the human body were not correctly recognized. Furthermore, the educational materials were effective because the scores and the percentage of correct answers increased after viewing the video materials. Furthermore, positive comments were expressed regarding the scenes of the experiments and the illustrations drawn by the students about the teaching materials. Conclusions: The contents that should be addressed more intensively were clarified, and the effectiveness of using video teaching materials in radiation nursing education was demonstrated. Full article

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. Conclusion: 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