Nurs. Rep., Volume 15, Issue 7 (July 2025) – 42 articles

Background: More than three years have elapsed since the onset of the full-scale invasion of Ukraine by the Russian Federation, displacing millions of Ukrainians. While preserving cultural identity in the host country is important for gaining resilience among refugees, we found no studies about how cultural identity influences health care experiences during resettlement. Objective: This study explores how cultural identity shapes health care experiences among Ukrainian refugees during resettlement in the United States. Methods: We conducted an interpretive description study using focus groups to elicit the perspectives of Ukrainian refugees who resettled in North Carolina after 24 February 2022. Twelve Ukrainian women participated in one of four focus groups. Thematic content analysis was employed for case comparison, and themes were inductively derived. Results: Two themes were identified: troubled health care partnerships and imprecise notions of preventive practices. Troubled partnerships represented a lack of trust between refugees and U.S. clinicians and the health care system. Imprecise notions of preventive practices represented mistaken beliefs about prevention. Conclusions: This study adds to the science on refugee health in two ways. First, newly arrived refugees often maintain strong ties to their homeland, which shapes their health care decisions and reinforces their cultural identity. Second, despite being well educated, some refugees held misconceptions about preventive health care, highlighting the need for clinicians to provide clear guidance on primary and secondary prevention practices. Findings may help guide clinicians in delivering culturally sensitive care to refugee populations. Full article

Hip fractures in elderly patients pose significant clinical challenges, confronting us with high morbidity and mortality rates. A comprehensive geriatric assessment plays an important role in determining prognosis as well as the indication for surgery. Aim: In this study, we aim to (1) assess frailty-based functional status in seniors with hip fractures, (2) evaluate geriatric assessment’s predictive value for postoperative recovery, and (3) analyze 1-year postoperative survival. Material and Methods: This prospective study included 60 senior patients admitted for hip fracture in the Orthopedics Department. Patients were examined using geriatric assessment instruments Mini Mental State Examination (MMSE), Geriatric Depression Scale (GDS), Mini Nutritional Assessment (MNA), and Frailty Groningen Indicator (GFI). We recorded the sex, marital status, number of comorbidities, and number of recommended drugs. Results: In total, 65% of patients were frail pre-surgery; the proportion increased post-surgery to 86.7%; (p = 0.005). Age greater than 80 years and unmarried marital status were associated with higher frailty risk (p = 0.04; p = 0.03). Preoperatively, important predictors of frailty were mild–moderate cognitive impairment (p = 0.017), mild–moderate depression (p = 0.01), and malnutrition (p = 0.04). Postoperatively, only mild–moderate cognitive impairment (p = 0.04) and mild–moderate depression (p = 0.01) proved to be important predictors of frailty. According to the ROC curve, good predictors of postoperative frailty were shown to be preoperative frailty and the degree of polypharmacy and comorbidity. Of all parameters predictive of postoperative frailty, only the number of medications reached statistical significance (p < 0.038). The study identified a 1-year all-cause mortality rate of 42.6% in elderly patients who underwent hip fracture surgery, with a significant association between mortality and preoperative MMSE, GDS, and MNA scores. Conclusions: Complex geriatric assessment of senior patients with hip fracture can stratify postoperative risk and predict 1-year mortality and postoperative functional recovery. Key predictors include cognitive status, depression, malnutrition, and comorbidities. Multidisciplinary care and standardized evaluation are essential for improving outcomes. Full article

Background: Around one-quarter of all people in the developed world die of cancer, with primary care being the main setting in which the disease is first suspected because the majority of patients consult a general practitioner (GP) when they present with symptoms. Diagnostic delay may thus be attributable to the patient, the GP, or the healthcare system. While some findings suggest that as much as half of the total delay consists of patient delay, more research is nonetheless needed into how GPs can facilitate access to diagnostic evaluation when patients experience symptoms. Methods: A retrospective observational study will be conducted to evaluate a cohort of patients diagnosed with cancer, with data being obtained from both primary and specialised care settings. Different time intervals will be analysed, dating from onset of first symptoms to diagnosis or initiation of treatment, and will be classified as: patient interval; primary-care interval; healthcare-system interval; diagnostic interval; treatment interval; and total interval. Study variables will include patient characteristics (socio-demographic, risk factors, morbidity, etc.), tumour characteristics (tumour stage, symptom onset, alarm symptoms, etc.), and healthcare characteristics (place of initial consultation, referral to specialised care, etc.). Discussion: The study will describe diagnostic delays in patients with cancer in primary care, considering the time elapsed between symptom onset and initial consultation, request for tests and/or patient referral, first evaluation in the hospital setting, and date of diagnostic confirmation and treatment initiation. Additionally, the study will make it possible to identify the patient-, healthcare-, and disease-related variables that intervene in the duration of such delays. Full article

Background: Family involvement in promoting patient safety is a strategy that is increasingly recognized. Nurses have a major role to play here. This study aims to know the family care process developed by nurses and explore the logistic process identified as support for the development of family care in ensuring patient safety in the hospital. Methods: An interpretative qualitative study was conducted through semi-structured interviews with 10 nurses selected by convenience. Content analysis was performed using Atlas.ti 9.1.7 software and Bardin’s methodology. Results: Two large families were identified according to the nature of the strategies mentioned by the participant/s: assistance process and logistic process, 5 categories and 23 subcategories. Care process categories: initial assessment, planning, and implementation. Categories of the logistic process: material and human resources and organization. Conclusions: To implement patient and family-centered care to ensure patient safety, it is necessary to adjust the care and logistic process. At the care level, the importance of the nursing process in the organization of care is evident. At the logistical level, organizational initiatives are needed to stimulate and support this philosophy of care and to intervene at the level of human and material resources. Full article

Background/Objectives: Pressure injuries (PIs), a recognized indicator of care quality, have a higher incidence in intensive care units (ICUs). Our objective was to assess whether critically ill patients identified as “unprotected” (COMHON ≥ 11) developed pressure injuries despite additional preventive measures. Methods: A historical cohort study of an adult ICU was carried out. Of the 811 patients admitted in 2022, 400 were selected. All of them were subjected to the ICU’s PI Prevention Protocol, and those with a moving average of the COMHON Index ≥ 11 were given two additional measures: a multilayer dressing on the sacrum, and anti-equinus and heel-pressure-relieving boots. Results: A total of 36 patients presented with PIs (cumulative incidence of 9%). Significant differences were observed in their mean length of stay and in their disease severity score (APACHE-II). Most of the PIs were located on the sacrum, followed by the heel. Prior to the appearance of the PIs, a sacral dressing was applied to 100% of the patients, while anti-equinus and heel-pressure-relieving boots were only applied to 58.3%. Of the 36 patients with PIs, 52.8% had a PI on the sacrum and 22.2% on the heel. Conclusions: Focusing only on those who presented with PIs, we observed that the considered measures were not effective for preventing PIs in all the patients. Not all PIs are preventable, and individual risk factors should be considered. In the future, we will analyze the individual characteristics of these patients and verify whether the Prevention Protocol was followed, in order to determine how they could have been prevented or whether they were so-called unavoidable PIs. Full article

Background/Objectives: Evidence-based practice (EBP) has been widely adopted in clinical nursing practice, with nursing education efforts consistently emphasizing its importance in strengthening implementation efforts. Despite these efforts to promote translational research, the level of implementation of evidence-based practice (EBP) in clinical nursing practice remains unsatisfactory. This study aimed to identify specific organizational, individual, and research-related barriers to the utilization of research in clinical practice among nurses in Sabah, Malaysia, to determine factors associated with these perceived barriers and to assess nurses’ awareness and understanding of the implementation of evidence-based practice. Methods: A cross-sectional study was conducted in 2019 using the BARRIERS scale, a validated tool that measures perceived barriers to the utilization of research across four domains: organizational barriers, nurses’ research awareness and values, quality of research, and research communication. This study involved nurses from five tertiary hospitals in Sabah, Malaysia. Results: A total of 562 nurses participated in the study, with a mean age of 34.3 years (SD = 7.96) and mean duration of clinical practice of 10.0 years (SD = 7.58). While 66.5% of the nurses had heard of EBP, only 7.3% reported understanding it very well. The top three barriers to the utilization of research were ‘the nurse does not feel she/he has enough authority to change patient care procedures’ (35.9%), ‘the nurse does not have time to read research’ (27.8%), and ‘research reports/articles are not published fast enough’ (25.8%). Among the four domains, organizational barriers scored highest (mean = 2.7, SD = 0.72), followed by research communication (mean = 2.6, SD = 0.73). Conclusions: The study findings emphasize the challenges nurses encounter in integrating research into clinical practice and highlight the need for ongoing efforts to promote the utilization of evidence-based practice and research among nurses in Sabah, while addressing the identified gaps. Full article

Background/Objectives: Psychological safety is essential for effective learning in high-fidelity simulation (HFS); however, no validated Japanese instrument currently exists to measure psychological safety among nursing students. This study aimed to translate the Psychological Safety in High-Fidelity Simulation (PS-HFS) scale into Japanese (PS-HFS-J) and evaluate its psychometric properties. Methods: Following COSMIN guidelines, the PS-HFS was translated through forward and back translation, reviewed by an expert panel, and tested for face validity via pilot testing. The scale’s reliability and validity were subsequently examined in 263 undergraduate nursing students using confirmatory factor analysis (CFA), Cronbach’s alpha, and intraclass correlation coefficients (ICC). Results: CFA confirmed a good fit of the original four-factor model (CFI = 0.990, TLI = 0.988, RMSEA = 0.026). The scale demonstrated excellent internal consistency (Cronbach’s α = 0.906 overall) and strong test-retest reliability (ICC range: 0.859–0.914). Content validity indices were also high (I-CVI = 0.80–1.00, S-CVI/Ave = 0.94). Conclusions: The PS-HFS-J is a reliable, valid, and culturally adapted instrument for assessing psychological safety in Japanese nursing education. It can support educational research, curriculum development, and faculty training, contributing to safer and more effective simulation-based education. Future studies should examine its applicability across diverse educational levels and clinical contexts. Full article

Background/Objectives: The Jackson/Cubbin scale is a recommended tool to assess the risk of pressure injury in intensive care unit (ICU) patients. This scale is deemed to have superior predictive validity compared to the Braden scale. Many Italian nurses struggle with reading and applying the tool in English. This language barrier results in a lack of use of the Jackson/Cubbin scale clinically, meaning that patients potentially experience worse outcomes. This study aims to translate the original English version of the Jackson/Cubbin scale into the Italian language, conduct a cultural adaptation, and verify its content validity. Methods: An observational study was conducted using Beaton’s five-step methodology: (1) forward translation, (2) synthesis, (3) back-translation, (4) expert committee approval using Fleiss’ Kappa (κ) index, and (5) pre-testing, where participants assessed item clarity on a dichotomous scale (clear/unclear). Items deemed unclear by 20% or more of the sample were revised. Content validity was assessed using the Content Validity Index (CVI). Results: Fleiss’ κ index was 0.74. Item 3 “PMH-affecting condition” was unclear to 36% of the sample and required revision. The item-level CVI (I-CVI) was >0.78 for each item. The scale-level CVI (S-CVI) and the scale-level CVI using the average method (S-CVI-Ave) were 0.92 and 0.94, respectively. Conclusions: The translation process resulted in a linguistically accurate scale requiring content modifications to reflect current evidence and reduce inter-rater variability. This may improve implementation of the Jackson/Cubbin scale in clinical practice for Italian nurses and reduce the incidence of pressure injury for ICU patients. Full article

Background: After an older person moves into a nursing home, the next of kin often continues to participate in the care provided there. This participation in care may contribute valuable knowledge of the preferences and wishes of the older person, thereby helping nursing staff deliver personalised care. Objectives: The aim of this study was to explore how next of kin experience their participation in the care of older persons residing in nursing homes after educating nursing staff about participation in palliative care. Methods: This follow-up study used a qualitative design based on semi-structured interviews with 37 next of kin. A thematic analysis was applied. Results: Participation of the next of kin involved active communication and collaboration with nursing staff, expressed in three themes: striving to achieve co-created care, navigating involvement through presence, and building commitment through communication and information. The dual role of being an emotionally close next of kin and a participant in the relative’s care was challenging and became increasingly burdensome and often overwhelming when the older person’s health deteriorated. Conclusions: This study reveals the need to develop and implement a policy for the participation of next of kin in the care of older people living in nursing homes. In addition, support groups can increase well-being through dialogue with other next of kin, thereby alleviating emotional strain. Increased implementation of life stories and the use of digital communication would keep the next of kin informed about the older person’s condition, especially when they cannot be present in person. Life story is a valuable tool for person-centred care and strengthens the relationships between the next of kin, the older person, and the nursing staff. Full article

Objectives: This study aims to explore the experiences of bereaved family members during and after the loss of a relative in an intensive care unit (ICU) during the COVID-19 pandemic-related visitation restrictions, as well as to assess their perceptions of a nurse-led bereavement support programme. Methods: Ten participants with a relative who had died in an ICU were recruited in September 2020 during a follow-up bereavement meeting at a tertiary cardiac centre in Switzerland. Descriptive qualitative research was conducted. Face-to-face nurse-led follow-up bereavement meetings, adapted to the pandemic circumstances and conducted as semi-structured interviews, were analysed by a thematic analysis. Findings: Fifteen sub-themes and three main categories were identified. The motivation behind the family members’ participation in the meetings was to ask and learn about their experiences regarding the death of their relative during this abnormal time. The reactions to the meetings varied among the families. Many expressed that the experience of bereavement was particularly challenging and painful, and that the absence of a final farewell to their loved one, as well as the impossibility of having a formally held funeral, made the deaths harder to accept. The families appreciated the interview as it gave them clarification, information, and an awareness of the facts and the care provided, and for several of them it was also a chance to share their emotions and express any difficulties they might have encountered both during and after the patient’s death. Conclusion: The COVID-19 pandemic’s restrictions had a profound impact on families who lost a loved one in an ICU. The nurse-led bereavement support service responded to the needs of grieving families, providing valuable emotional and practical support and re-establishing a healthy relationship between the families and the caregivers that was hindered by pandemic restrictions. The study also shows that a nurse-led bereavement support service can be a valuable component of family-centred care. Full article

Background/Objectives: In contemporary nursing education, clinical competence and psychological resilience are both essential; however, they are often treated as separate outcomes. Clinical placements are a central component of nursing education, and often expose students to high levels of stress, emotional challenges, and complex clinical demands. Building both clinical competence and psychological resilience during this phase is crucial to preparing students for the realities of professional practice. This narrative review, grounded in Bandura’s social cognitive theory (SCT), explores how educator behaviors, teaching strategies, and learning environments interact to influence both domains in undergraduate nursing students. Methods: A comprehensive search was conducted in PubMed, CINAHL, and PsycINFO for peer-reviewed articles published between 1 January 2000 and 2 May 2025. Relevant studies were thematically analyzed and were guided by Bandura’s SCT constructs, including observational learning, self-efficacy, and reciprocal determinism. No formal study appraisal was conducted due to the narrative nature of the review. Findings: Nineteen studies were included in the review. The findings highlight that reflective practices, structured feedback, peer learning, and strategies to build self-efficacy are central to building resilience and competence. Supportive educator behaviors such as mentoring, emotional support, and professional role modeling, were strongly associated with increased student confidence, emotional regulation, and adaptability. Psychologically safe clinical learning environments further enhanced self-efficacy and active engagement. In contrast, unsupportive or inconsistent environments were linked to student stress, disengagement, and reduced performance. Conclusions: This review highlights the need to move beyond traditional competency-based models toward an integrated approach that equally values psychological preparedness and resilience. Findings suggest a shift toward emotionally and socially integrated clinical education. Full article

Background/Objectives: In Australia, attrition rates in undergraduate nursing degrees have been increasing nationally. The aim of this study was to explore if and how clinical laboratory-based peer-assisted learning (PAL) improved the first-year nursing student learning experience and retention at a regional university. A further aim was to explore any perceived benefits for third-year student participants. Methods: This is a descriptive study design. The study recruited eight third-year nursing students (named ‘LabPALs’) offering support to 42 first-year nursing students during their self-directed laboratory practice sessions. The first-year students included a high percentage of mature aged and ‘first in family’ students. Over an eight-week period, LabPALs provided peer support for up to four students per one-hour practice session. Unit grade outcomes were compared with students not exposed to the PAL sessions. Both the LabPAL mentors and first-year participants were asked to evaluate their experience. Results: It was found that PAL project participation was associated with higher completion rates when compared with non-participation. When combined with exposure to their experienced peers’ perspectives and support, participation was associated with academic success. Thematic analysis found that first-year nursing students reported developing both ‘confidence’ and ‘competence’ in their laboratory learning spaces. The third-year LabPAL students reported skills gained in facilitating peer learning and perceived their experience as very rewarding. Conclusions: This research suggests that PAL enhances clinical laboratory learning among undergraduate nursing students. Full article

Background/Objectives: The role of the primary health care nurse has evolved since the Spanish Ministry of Health officially established the professional profile of the nurse specialist in Primary Health Care in 2005. Despite the potential benefits of this new professional profile in the population’s health, their actual scope of practice is still unknown and still largely underutilized. This study aimed to explore demands and expectations of adult primary health care service users regarding the role of the nurse specialist in primary health care. Methods: A nationwide cross-sectional study consisted of a computer-assisted telephone survey to a random sample of 1200 adults living in Spain. A self-developed 19-item instrument assessed population’s perception of the role of the nurse specialist in primary health care. Descriptive, bivariate and logistic regression models explored associations between sociodemographic characteristics with perception of the nurse specialist role. Results: Most participants (82.3%) would choose a nurse specialist in primary health care and consider that the nurse specialist in primary health care should expand their scope of practice requesting diagnostic test (70%) and prescribing medications for chronic diseases (63.8%). Conclusions: Results show a population’s positive perception towards expanding the scope of practice of the nurse specialist in primary health care in the Spanish healthcare system. Primary health care models should acknowledge the potential of expanding the competencies of this professional profile. Full article

Introduction: Work life quality (WLQ) in nursing is a critical factor that influences both staff well-being and the quality of care provided to patients. Spiritual intelligence (SI) and servant leadership (SL) have been identified as potential positive predictors of WLQ, as they facilitate resilience, job satisfaction, and stress management in highly demanding hospital environments. However, the specific relationship between these constructs in the Peruvian nursing context has not yet been thoroughly explored. Objective: We aimed to examine the impact of spiritual intelligence and servant leadership on the work life quality of Peruvian nurses, assessing their predictive role through a structural equation modeling approach. Methods: A cross-sectional and explanatory study was conducted with a sample of 134 Peruvian nurses (M = 36.29 years, SD = 7.3). Validated Spanish-language instruments were used to measure SI, SL, and WLQ. Structural equation modeling (SEM) with a robust maximum likelihood estimator (MLR) was employed to evaluate the relationships between the variables. Results: Spiritual intelligence showed a positive correlation with WLQ (r = 0.40, p < 0.01) and with servant leadership (r = 0.44, p < 0.01). Likewise, servant leadership had a significant relationship with WLQ (r = 0.53, p < 0.01). The structural model demonstrated a good fit (χ² = 1314.240, df = 970, CFI = 0.96, TLI = 0.96, RMSEA = 0.05, SRMR = 0.08). The hypothesis that SI positively predicts WLQ was confirmed (β = 0.41, p < 0.001), as was the significant effect of SL on WLQ (β = 0.26, p < 0.001). Conclusions: The results indicate that both spiritual intelligence and servant leadership are key predictors of work life quality in Peruvian nurses. SI contributes to developing a transcendent perspective on work and greater resilience, while SL fosters a positive and motivating organizational environment. It is recommended to implement training programs and leadership strategies focused on these constructs to enhance work life quality in the healthcare sector. Full article

Technological advancement has radically transformed higher education, requiring faculty members to continually adapt to new tools and teaching methods. In this context, the phenomenon of fear of missing out (FoMO) has gained relevance, often manifesting through a range of negative emotional states, including technostress—stress associated with the use of technology. Objectives: This study aimed to map the available scientific evidence on technostress among nursing faculty in higher education, through a scoping review conducted according to the methodology proposed by the Joanna Briggs Institute (JBI). Methods: The literature search was performed across eight databases, including Medline (via PubMed), CINAHL Complete, Scopus, and the Teacher Reference Center. Results: Of the 266 studies identified, only 3 met the inclusion criteria. Conclusions: Findings reveal varying levels of technostress among nursing educators, with higher levels observed among older faculty members, frequently associated with limited technical and administrative support. Although the direct impact on job satisfaction was not significant, the anxiety induced by intensive technology use and the perceived necessity for constant professional updating—often driven by FoMO—was shown to affect daily academic life, highlighting the need for effective coping strategies. Understanding technostress within the context of nursing education is essential for addressing the challenges of pedagogical modernization. This review supports the need for future institutional interventions aimed at preventing technostress and fostering a more balanced, reflective, and sustainable relationship with technology in academic settings. Full article

Background: The leadership style employed by those in positions with authority could significantly impact employees’ work behavior, either positively or negatively. Objectives: The aim of the study was to examine the impact of engaging leadership on quiet quitting and work engagement among nurses. Methods: A cross-sectional study was conducted in Greece with a convenience sample. Data collection occurred throughout October 2024 via an online survey. We utilized Google forms to create an online version of the study questionnaire, which was subsequently shared in Facebook groups for nurses. We used validated tools to measure our study variables, namely, the “Engaging Leadership Scale-12” for engaging leadership, the “Quiet Quitting Scale” for quiet quitting, and the “Utrecht Work Engagement Scale-3” for work engagement. We applied univariate and multivariable linear regression analyses to identify the association between engaging leadership, quiet quitting, and work engagement. p-values less than 0.05 were considered statistically significant. Results: Our multivariable models showed a negative association between engaging leadership and quiet quitting. Moreover, we found a positive association between engaging leadership and work engagement after the elimination of confounders. Conclusions: Our findings suggest that higher levels of engaging leadership reduce quiet quitting and improve work engagement. Nurses’ managers should adopt engaging leadership to improve nurses’ motivation and, thus, clinical outcomes. Full article

The aim of this work is to explore and understand the lived experience of nurses who chose to schedule visits with an Emotional Support Animal (ESA), i.e., a dog, during their working shift. Background/Objectives: Nursing practice is rigorous, weighted with intense responsibility that creates an environment conducive to stress and anxiety for the nurses, who have reported a higher level of work stress than other healthcare professionals. Knowing and addressing the factors impacting mental health/nurses’ well-being is crucial to providing care to patients. Stressful work environments result in burnout, compassion fatigue, depression, anxiety, suicide, and resignation. Understanding nurses’ perspectives on work related stress encourages hospitals to structure practices supporting nurses’ mental health and ability to provide quality care. Methods: A qualitative hermeneutic phenomenological approach was employed. Participants scheduled six weekly 10-min visits with Rex, a certified Service Dog for anxiety depression and PTSD, and registered ESA. A sample of 11 RNs participated in Rex visits at the workplace; field notes were taken during observations of visits. Semi-structured 30-min interviews conducted via Zoom, audio-recorded, and transcribed with NVivo were conducted. Results: Data were examined with Interpretative Phenomenological Analysis. Four main themes emerged: Preparing for the unknown, Doing the work, Refueling and resetting-Visits with Rex, What about nurses? Conclusions: This study highlights the need for nurses and hospital systems to incorporate self-care/self-reflection, including time/opportunities for nurses’ stress management during their practice. Knowledge of nurses receiving ESA interventions sheds light on how to protect/preserve the well-being of nurses practicing in this demanding profession. ESAs for nurses in the workplace offers an option to utilize dog therapy to re-energize and continue their shift renewed and refreshed. Full article

Background: Violence against healthcare professionals is a growing public health concern. In Spain, the National Observatory of Aggressions recorded 16,866 cases in 2024, marking a 103.06% increase since 2017. This phenomenon has intensified in recent years, with serious repercussions for both the physical and psychological well-being of healthcare workers, as well as for the quality of care provided. Objectives: This descriptive study examines the knowledge, perceptions, and experiences of workplace aggression among undergraduate students at the University School of Nursing of the Nuestra Señora de Candelaria University Hospital. Materials and Methods: A self-administered ad hoc questionnaire was distributed to 266 students across all academic years to assess their knowledge and to explore their perceptions and experiences of aggression witnessed or experienced during clinical placements. This study was guided by the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Results: The findings revealed significant educational gaps among students regarding how to manage aggressive situations, as well as high levels of concern and an aggression exposure rate exceeding 30%. A statistically significant association was also observed in relation to the academic year. Conclusions: This study provides a foundation for the development of specific training programmes tailored to the needs identified and for enhancing occupational safety in healthcare settings. Full article

Background: It is generally well-known that narration of care is critically important to high-quality nursing care. Narration of care is loosely defined as a nurse’s ability to describe to patients and families the clinical purpose behind nursing practice, what is hoped to be achieved, and the “why” (or clinical rationale) behind nursing activities. Despite the importance of narration of care, there is little practical guidance given to nurses about how to narrate care—what makes for effective or ineffective narration of care. Objective: Our aim was to develop a framework for teaching nurses and patient care assistants (PCAs) on how to effectively narrate care. In this article, we provide a practical framework for teaching nurses and PCAs how to narrate care. We describe the process of developing the framework as part of quality improvement efforts and implementing a course for eight hospitals based on the framework. Methods: Consistent with a Plan-Do-Study Act (PDSA) quality improvement approach, we developed the framework by first conducting a data and literature review, then convening a taskforce, discussing with patients on our existing committees, and finally formulating a framework. We then drafted supplementary cases and course material and implemented a course to teach nurses and PCAs how to narrate care. Results: The narration of care framework (NOC) that we developed and implemented consisted of the following five principles, which can be called RECAP as an acronym: 1. The “R” in RECAP stands for removing uncertainty. 2. The “E” in RECAP stands for explaining the environment. 3. The “C” in RECAP stands for being calm and sincere. 4. The “A” in RECAP stands for assume nothing. 5. The “P” in RECAP stands for personal connection. As for the course developed based on the RECAP principles, there was a total of 276 course offerings conducted by 30 facilitators, and 7341 nurses and PCAs completed the course. The evaluations reflected that 99% of learners believed their learning was improved by the course. Discussion: There are several multifaceted benefits to NOC: nurses’ and PCAs’ capability to narrate care well shows empathy and compassion to patients; it strengthens patient understanding and education that can lead to improved patient outcomes; and it helps allay patients’ uncertainties and anxieties. In essence, narrating care in an effective manner cultivates a strong nurse–patient therapeutic relationship. Yet, in the absence of any practical guidance, nurses and PCAs are left to develop narration skills on their own, learning by trial and error, and, in doing so, perhaps failing to meet patients’ needs and failing to fully derive the many benefits that the NOC is designed to achieve. Our hope is that, if hospital systems adopt our work, nurses and PCAs can comfortably and confidently enter the profession knowing the purpose or narrating care, its many benefits, and how to practically conduct sufficient narration, and what would constitute insufficient narration. Hospitals, in turn, can specify and clearly articulate their expectations for nurses and PCAs narrating with patients—what would make for a strong, compassionate process and what would be inadequate. For more experienced nurses, they can use the RECAP framework to reflect on their own practices and perhaps strengthen or refreshen existing skills. Conclusions: NOC is acknowledged, somewhat implicitly, as being critical to nursing and PCA practice, yet practical instruction and specified principles are lacking. We aimed to fill this gap by developing, implementing, and teaching a practical framework, armed with many tools nurses can use. Full article

Background/Objectives: This study protocol outlines the implementation of a professional development programme (ProDeveloP) designed to support newly graduated nurses (NGNs). NGNs often experience inadequacy and face challenges in developing their professional competence. Healthcare organisations can ease this transition through introduction programmes. However, effective implementation strategies in local healthcare settings remain unclear. This study aims to develop, implement, and evaluate a programme that enhances role clarity, task mastery, social acceptance, stress reduction, and recovery, contributing to increased job satisfaction and retention. Methods: ProDeveloP will be implemented at a regional hospital in mid-Sweden. This study will include a convenience sample of 110 NGNs from both the previous and the new introduction programmes, 20 dialogue facilitators involved in the programme, and 10 managers responsible for NGNs participating in the programme. Data will be collected throughout the ProDeveloP using questionnaires, individual interviews, and focus groups. The data will be analysed using both qualitative and quantitative analyses. Conclusions: This study has the potential to improve NGNs’ work-related health, job satisfaction, and retention while contributing to competence development. By offering structured reflection, mentorship, and organisational support, this research project addresses knowledge gaps in understanding the long-term impacts of introduction programmes and structured reflection, contributing to evidence-based improvements in nursing practice and healthcare leadership. Clinical trial number: NCT06742047. Registered in ClinicalTrials.gov, 19 December 2024. Full article

Surgical Site Infection (SSI) can be a devastating complication, leading to increased morbidity, mortality, and healthcare costs. Pre-surgical hand preparation is an effective strategy to prevent SSI. The two most common pre-surgical hand preparation methods are antimicrobial soap for surgical hand scrub and alcohol-based surgical hand rub. The antimicrobial soap hand scrub remains more commonly used among operating theater staff. However, several studies showed that alcohol-based hand rubs are much more effective than antiseptic soap hand scrubs. Objective: This study aimed to compare the effect of the two methods of surgical hand preparation on the number of bacterial colonies. Methods: The design of this study was a comparative study with a pre-test and post-test approach in two groups (a surgical hand scrub using 4% chlorhexidine soap group and a surgical hand rub using 70% ethyl alcohol and 2.5% chlorhexidine group). Hand smear sampling was performed before surgical hand preparation (pre-test), immediately after surgical hand preparation (post-test 1), and after the surgery was completed (post-test 2). Seventy-one hand smear samples (35 samples applied the surgical hand rub, and 36 samples applied the surgical hand scrub) were divided into two groups and examined for colony counts in Colony Forming Units (CFU) using the total plate count method. Descriptive and comparative analysis were applied. Results: The surgical hand-scrub group had average pre-test, post-test 1, and post-test 2 colony counts of 0.202 CFU/cm², 0.007 CFU/cm², and 0.016 CFU/cm², respectively, while the surgical hand-rub group had average pre-test, post-test 1, and post-test 2 colony counts of 0.163 CFU/cm², 0.001 CFU/cm², and 0.001 CFU/cm² respectively. Statistical analysis using the Friedman test showed that both methods significantly reduced the number of colonies (p < 0.01). Based on the Mann–Whitney test, there was no significant difference between the two groups regarding the number of colonies (p > 0.05). Conclusions: Surgical hand-scrub and hand-rub have similar effectiveness in reducing and maintaining the number of colonies on hands during surgery, both gram-positive and gram-negative bacteria. Full article

Background: Work engagement is essential to the well-being of nurses and the quality of health care, particularly in high-demand urban hospital environments in Bangkok. To determine the levels of work engagement—vigor, dedication, and absorption—among nurses in a Thai urban tertiary hospital, and to identify associated demographic and occupational predictors. Materials and Methods: A cross-sectional study was conducted among 650 nurses at a tertiary university hospital in Bangkok, Thailand, from February to March 2025. Participants were selected through simple random sampling. They completed an online survey including demographic data and the Utrecht Work Engagement Scale (UWES), which assesses three dimensions of engagement: vigor, dedication, and absorption. To identify the predictors of high engagement levels, chi-square tests and multivariate binary logistic regression were used. Results: Most nurses reported low engagement across all dimensions: 73.1% for vigor, 69.1% for dedication, and 70.0% for absorption. In the adjusted models, monthly income was a significant predictor of higher vigor and dedication, whereas no significant predictors emerged for absorption. Other variables, including age, experience, and professional rank, were significant in the bivariate analyses but not in the multivariate models. Conclusions: Nurse engagement remains suboptimal in the urban tertiary hospital setting, with financial compensation emerging as a key determinant. Strategic interventions to improve income equity and career development may help enhance engagement and retention in the nursing workforce. Full article

Background/Objectives: Preventive health behaviors are key to disease prevention and health system sustainability; however, population-level factors remain understudied in multilingual regions. South Tyrol, an autonomous multilingual province in Northern Italy, provides a unique setting to examine how sociodemographic and linguistic factors shape preventive behaviors. Methods: A stratified, population-representative survey of 2090 adults (aged ≥18 years) was conducted in South Tyrol in 2024. Preventive behavior was assessed using the validated 16-item Good Health Practices Scale (GHP-16). Key predictors included age, sex, education, living situation, language group, employment in the health/social sector, health literacy (HLS-EU-Q16), patient activation (PAM-10), and the mistrust of professional health information. Weighted statistics and multivariable linear regression were used to identify associations. Results: The GHP-16 scores varied significantly across sociodemographic and psychosocial strata. Female sex, older age, higher education, higher patient activation, and sufficient health literacy were independently associated with greater engagement in preventive behaviors. Patient activation showed the strongest graded effect (β = 1.739). The mistrust of health professionals was inversely associated with behavior (β = –0.050, 95% CI: –0.090 to –0.009). Italian speakers reported higher GHP-16 scores than German speakers (β = 0.377), even after adjusting for covariates. Item-level analysis revealed small but consistent differences, particularly in information-seeking and vaccination behavior. Conclusions: Preventive behaviors in South Tyrol are shaped by demographic, psychosocial, and linguistic factors. Patient activation and health literacy are key modifiable predictors, whereas language group differences suggest structural and trust-related disparities that require tailored public health strategies in multilingual settings. Full article

Background/Objectives: Quiet Quitting (QQ) describes a state of reduced workplace engagement characterized by a lack of motivation and initiative. Employees practicing QQ typically limit their efforts to fulfilling only their assigned tasks, expending the minimum necessary energy, while still ensuring the completion of their core responsibilities. QQ is an emerging phenomenon in healthcare settings following the COVID-19 pandemic and is still relatively unexplored in the literature. The aim of this study is to assess QQ among nurses in a northern Italian hospital. Methods: A cross-sectional study with a convenience sample of 91 nurses in a single-specialist orthopedic hospital was conducted. Data were collected in August 2024 using an online form of the Quiet Quitting Scale (QQS). Demographic data were collected, including gender, age, years of work experience and department. Results: A response rate of 83.50% was recorded. Data analysis revealed that 46.06% of the sample (35 nurses) was identified as quiet quitters. Fewer years of service and a younger age were associated with a higher probability of Quiet Quitting. The highest average score was observed for “Lack of motivation” subscale at 2.40 (SD = 1.14). Conclusions: The findings establish QQ as a significant issue requiring urgent attention in healthcare. To guarantee high-quality nursing care, healthcare organizations must prioritize interventions focused on enhancing employee support and work environment. Longitudinal research is necessary to explore the long-term effects of QQ on patient outcomes and to evaluate the success of targeted interventions. Full article

Background/Objectives: The under-five mortality rate (U5MR) remains a serious health challenge in Indonesia, with low birth weight (LBW) being a key risk factor. This study aimed to identify predictors of survival among under-five children with LBW using data from the 2017 Indonesia Demographic and Health Survey (IDHS). Methods: This cross-sectional study included 625 children under five with LBW. The dependent variable was under-five mortality (children aged 0–59 months), while the independent variables include child (gender), maternal (age at delivery, education, empowerment, delivery complications, and breastfeeding history), health service (antenatal care-ANC and place of delivery), and household (wealth quintile and residence) factors. Data were obtained from the 2017 IDHS using household and women’s questionnaires and analyzed using univariate analysis, Kaplan–Meier estimation, and Cox regression. Results: 41 of 625 children born with LBW died before the age of five. The Kaplan–Meier estimation found that maternal (delivery complications and breastfeeding history), health service (ANC history and place of delivery), and household factors (residence) significantly influenced the survival of LBW children. The Cox regression results showed that LBW children who were breastfeed and whose mother had adequate antenatal care visits had a lower risk of under-five mortality. Surprisingly, children born in health facilities had a significantly higher risk of death compared to those born elsewhere. Conclusions: Exclusive breastfeeding, adequate antenatal care, and place of delivery are important determinants of survival among children born with LBW. This support targeted interventions to improve the survival chances of children born with LBW, particularly in their early years of life. Full article

Background: Sexual assault affects millions globally each year, yet research on survivors’ resilience remains limited and methodologically inconsistent. Resilience after sexual assault is a multidimensional and deeply personal process shaped by psychological, social, and systemic influences. Understanding this complexity requires research methodologies that can capture both measurable patterns and lived experiences. Objectives: This integrative review explores how mixed-methods research (MMR) has been used to study resilience and healing following sexual assault. Methods: Using the framework by Whittemore and Knafl, four databases (PubMed, CINAHL, PsychInfo, and EMBASE) were searched for peer-reviewed primary research articles published between 2014 and 2024. Studies were screened and appraised independently by two reviewers using predefined inclusion and exclusion criteria and a modified Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) tool. Results: Six studies met the inclusion criteria, revealing substantial variation in how mixed-methods approaches were applied. Half of the studies cited a “completeness” rationale for integrating qualitative and quantitative strands, while others emphasized enhancement, triangulation, or discovery of new insights. Integration strategies included connecting datasets sequentially, merging findings at the interpretation stage, or building new frameworks from combined results. However, only one study used a joint display to visually represent integration, highlighting an ongoing underutilization of visual synthesis tools in trauma research. Measures of resilience and associated outcomes also varied widely across studies, underscoring the complex and multidimensional nature of resilience following sexual assault. Conclusions: This review suggests that MMR can offer a deeper, more nuanced understanding of resilience among sexual assault survivors and calls attention to the need for intentional integration strategies to maximize insight. Full article

Background: The concept of evidence-based practice (EBP) is globally relevant in current healthcare climates. However, nursing students and teachers often struggle with integrating EBP effectively into a curriculum. This has implications for the way students learn to use evidence for their nursing practice. A new undergraduate EBP module was co-designed with current nursing students and university staff throughout 2023. Underpinning the module was a UDL (universal design for learning) pedagogy consisting of flexible approaches to learning for nursing students which included co-developed videos, co-developed audio podcasts, and co-developed serious games to complement traditional flipped classroom learning. The module commenced in September 2023, running in Year 1 one of a 3-year undergraduate nursing program, and was co-taught by staff and senior students. Methods: A pre/post-test design was used to collect data on student attitude, knowledge, and utilization of EBP. A total of 430 students completed two validated questionnaires, the EBP Beliefs Scale© and EBP Implementation Scale©, before and after the module. Following the post-test, six focus group interviews were also conducted with 58 students to explore how the module informed student nursing practice whilst attending clinical placement during Year 1. A convergent mixed-methods design was employed. Sample attrition occurred (~25%). Effect sizes and 95% confidence intervals were calculated for primary outcomes. Results: Quantitative data was analyzed using paired t-tests and this highlighted statistically significant improvements in attitude, knowledge and utilization of evidence-based practice after learning (p < 0.001). Qualitative data was transcribed verbatim, thematically analyzed, and highlighted three main findings; EBP is my business, EBP positively influenced the care of my patients and EBP has positively impacted my professional development. Conclusions: Partnership with current nursing students in the co-design and implementation of a module about EBP was associated with improvements in student knowledge, attitude and utilization of evidence in practice. These factors are likely to also improve professional competence and ultimately patient care. Full article

Background/Objectives: Inequalities in access to nursing professionals represent a significant challenge to achieving equity in healthcare systems. In decentralized countries like Italy, disparities in the distribution of nurses persist despite a universal national health system. This study investigates the extent and determinants of regional inequality in the distribution of the nursing workforce in Italy. Methods: A retrospective ecological analysis was conducted using administrative data from official national sources (ISTAT, Ministry of Health) concerning the number of nurses and population per region, along with Human Development Index (HDI) data from 2021. Descriptive statistics, the Gini coefficient, Lorenz curve, and Pearson correlation were used to assess inequality and identify influencing factors. Results: The national Gini coefficient was 0.136, indicating a moderate degree of inequality in the distribution of nurses across Italian regions. A strong positive correlation was observed between HDI and nurse-to-population ratio (r = 0.76, p < 0.001), suggesting that more developed regions have higher nursing density. Conclusions: Despite a universal healthcare system, Italy shows persistent regional disparities in nurse distribution. These findings emphasize the need for targeted policies and coordinated planning to reduce inequalities and ensure equitable access to nursing care across all regions. Full article

Workplace violence is a widespread issue affecting hospital nursing staff and significantly undermines their psychological well-being. Such violence originates from various sources, including users, colleagues, and supervisors. Psychological resilience has been linked to more favourable indicators of well-being. Background/Objectives: This study aimed to explore how different sources of workplace violence (users, colleagues, and supervisors) are related to psychological well-being and psychological resilience. Additionally, it examines whether resilience is statistically associated with a mediating role in the relationship between source-specific workplace violence and the psychological well-being of hospital nurses. Methods: A cross-sectional, multicentre, descriptive, and mediational study was conducted with a sample of 447 hospital nurses. Participants completed a self-administered questionnaire assessing workplace violence from users, colleagues, and supervisors, alongside measures of resilience, psychological well-being, and sociodemographic characteristics. Results: Among all reported incidents of workplace violence in the previous year, 69.2% were attributed to users, with verbal abuse (68.7%) being more prevalent than physical aggression (24.1%). Additionally, 37% of nurses reported experiencing violence from colleagues, and 25% from supervisors. Workplace violence from all three sources was significantly associated with both psychological well-being and resilience. Resilience was statistically associated with a mediating role in the relationship between workplace violence and nurses’ psychological health, suggesting a potential mechanism of influence without implying causality. Conclusions: The prevalence of workplace violence from users, colleagues, and supervisors among hospital nurses is notably high. Findings indicate that violence from any of these sources is negatively associated with psychological well-being. However, resilience mitigates this impact by reducing psychological distress, positioning it as a crucial personal resource for nurses facing such adversity. These results underscore the need for interventions aimed at developing and strengthening resilience among hospital nursing staff. Moreover, the findings can inform the design of organisational strategies to prevent violence and to promote resilience and well-being within healthcare settings. Full article