Nurs. Rep., Volume 15, Issue 8 (August 2025) – 45 articles

Background/Objectives: This study conducted a secondary and integrative analysis of qualitative data on adolescents and young adults (AYAs) with biliary atresia who survive with their native livers. These individuals struggle with independence and self-care due to prolonged parental involvement. Prior studies have insufficiently clarified how AYAs and parents jointly navigate daily responsibility transitions during this period. Therefore, we aimed to elucidate this process and develop a practical model to support nursing care. Methods: Semi-structured interview data from eight adolescent–parent dyads (one male and seven females, aged 17–25; one father and seven mothers, aged 40–60) were reanalyzed using the modified grounded theory approach. By reframing the analytical focus on dyadic interactions, four transition phases were identified, which were then integrated with the findings of two prior studies to construct an integrative process model. Results: The transition comprised four phases: (1) parent-led recuperation, (2) a vicious cycle of control and rebellion, (3) passing the axis of responsibility, and (4) aligning the parent–child rhythm to create a patient-centered life. The transition processes were shaped by changes in cognition and behavior. The model illustrates mutual adaptation through communication, negotiation, and reflection, identifying opportunities for nursing intervention. Conclusions: This process model offers a practical framework for nurses to assess readiness for care transitions, support transitional role shifts, and co-develop care strategies. The model provides insights into relationship-based communication and shared decision-making in transitional care by capturing the relational dynamics between AYAs and their parents. Full article

Background: Simulation-based education (SBE) is a key component of nursing training. It enables students to apply theoretical knowledge in practice, expand their clinical understanding, develop critical thinking, improve communication skills, and build self-confidence. Increasing the number of simulation hours in nursing curricula may enhance students’ ability to manage stress in clinical settings. Methods: This was a cross-sectional comparative study involving 113 nursing students during a practical exam. Participants graduated in three consecutive years: 2020, 2021, and 2022. SBE was introduced into the curriculum in 2020, resulting in varying levels of simulation experience. Stress and anxiety markers were measured during the exam and compared across groups. Results: Greater simulation experience was associated with lower heart rate (p = 0.007), lower diastolic blood pressure (p < 0.001), and lower cortisol levels (p < 0.001). Students with two years of simulation training reported the lowest perceived stress (p = 0.031). However, anxiety levels remained high across all groups and did not differ significantly. Conclusions: The study showed that OSCEs are associated with elevated stress in nursing students. Students with greater exposure to simulation-based education had significantly lower stress and anxiety indicators. SBE appears to reduce stress and improve students’ preparedness for clinical assessments. Full article

Background/Objectives: Parents of individuals with substance use disorders (SUDs) often carry significant emotional and relational burdens, yet their voices remain underrepresented in addiction research. This study explores how Greek parents navigate the long-term challenges of caring for adult children with SUDs, with a focus on emotional strain, caregiving identity, and culturally embedded coping strategies within a collectivist context. Methods: Eight Greek parents (six mothers and two fathers, aged 47–60) participated in in-depth, semi-structured interviews. Conversations were conducted either in person or via video call, depending on participant preference and geographical constraints. Data were analyzed using Interpretative Phenomenological Analysis (IPA) to explore lived experience and the meaning-making processes shaping parental coping over time. Results: Four overarching themes were identified as follows: (1) Living in Vigilance, reflecting constant hyper-alertness, emotional exhaustion, and social withdrawal rooted in trauma; (2) Shifting Parental Identity, capturing the evolution of parents into caregivers, advocates, and informal caseworkers amid systemic neglect; (3) Struggling Within Systems, highlighting exclusion, blame, and fragmentation in institutional care—with moments of empathy holding outsized emotional weight; and (4) Coping as Cultural Duty, showing how caregiving was sustained through values of sacrifice, loyalty, and protective silence, even at great personal cost. Conclusions: Greek parents supporting adult children with SUDs face a complex interplay of trauma, cultural obligation, and institutional strain. Their coping is shaped by deeply held familial values rather than access to effective support. The findings call for culturally attuned, family-inclusive interventions and further research into long-term caregiving across diverse contexts. Full article

Background/Objectives: The mental health and engagement of nursing students are critical for academic success and professional readiness. This study explored the impact of an 8-week Hatha yoga programme on undergraduate nursing students’ engagement, depression, anxiety, stress, procrastination, sense of belonging, and intention to drop out. Methods: A mixed-methods design was employed, collecting data pre- and post-intervention between July 2023 and November 2024. Fifty-nine students initially enrolled in the study, with fourteen completing the full yoga programme and post-intervention assessments. Quantitative data were analysed using descriptive and non-parametric statistical tests, while qualitative data from semi-structured interviews were analysed thematically to capture students’ lived experiences. The study has been guided by the STROBE guidelines. Results: Statistically significant reductions in depression, anxiety, and stress were observed among students who completed the yoga programme. Improvements in behavioural and emotional engagement were also noted. Qualitative findings revealed that yoga fostered a renewed sense of wellbeing, self-care, and resilience, particularly among students balancing academic, work, and family responsibilities. Conclusions: Participation in an 8-week yoga programme was associated with reduced psychological distress and enhanced engagement among nursing students. These findings support the integration of holistic self-care practices into nursing curricula to promote student wellbeing and academic persistence. Full article

Background: Solid organ transplantation improves survival and quality of life but requires lifelong self-management. While models exist for kidney and liver recipients, a comprehensive framework for all solid organ transplant recipients is lacking. Addressing this gap is essential for optimizing post-transplant care. Objectives: This report aims to conceptualize self-management after solid organ transplantation by addressing questions related to (1) the contexts studied to date, (2) research methodologies and publication types used, and (3) core aspects associated with self-management post-transplantation. Methods: A scoping review was used to address the above objectives. A comprehensive search strategy identified relevant studies, followed by systematic screening, data extraction, and qualitative content analysis. Findings were categorized using a deductive–inductive coding approach to map core self-management aspects after solid organ transplantation. Results: The search yielded 34,417 records, with 742 ultimately included. Publications from 43 countries spanned 43 years, with many (48.9%) published after 2016. Research articles dominated (80.1%), covering kidney (61%), liver (22%), heart (21%), and lung (16%) transplants. A qualitative analysis identified four self-management domains containing various categories: (1) Managing the medical–therapeutic regimen, (2) managing biographical work, (3) managing (new) life roles, and (4) generic self-management skills. The conceptual model illustrates their interconnections, with aspects of the medical–therapeutic regimen management most frequently covered. Conclusions: Self-management after solid organ transplantation is complex, involving medical–therapeutic, emotional, social, and behavioral aspects. Aspects of managing the medical–therapeutic regimen dominate the research literature, while other aspects need further exploration. Future studies should address gaps to support holistic, patient-centered post-transplant care strategies. Full article

Background: Exercise rehabilitation is a crucial component of stroke recovery, particularly for patients transitioning to home or community settings. However, there is currently a lack of self-reported scales designed to measure the level of engagement in exercise rehabilitation among patients with stroke. Objective: To develop and validate psychometric properties of the Engagement in Exercise Rehabilitation Scale for patients with stroke. Methods: The initial item pool was extracted from a literature review and a semi-structured interview with patients with stroke. The development and refinement of the items underwent expert consultation and cognitive interviews with patients with stroke. The items primarily covered patients’ perceptions, emotional attitudes, and specific engagement behaviors regarding exercise rehabilitation in home or community settings. A total of 260 patients with stroke were selected to test the reliability and validity. The psychometric proprieties test included construct validity, content validity, criterion-related validity, exploratory factor analysis, internal consistency reliability, test–retest reliability, and split-half reliability. Results: The final version of the Engagement in Exercise Rehabilitation Scale comprised 20 items. The scale’s content validity index was determined to be 0.976, while the item-content validity indices ranged from 0.833 to 1.000. Results from exploratory factor analysis indicated that this scale is unidimensional, with a cumulative variance contribution rate of 79.3%. The test–retest reliability of the scale was found to be 0.879, its split-half reliability was measured at 0.980, and its Cronbach’s α coefficient was calculated to be 0.986. Conclusion: The Engagement in Exercise Rehabilitation Scale for patients with stroke demonstrates accepted reliability and validity. The accuracy and generalizability of this scale necessitate further validation through additional large-sample studies involving diverse populations across multiple centers. Full article

Background: As global populations age, the demand for effective and compassionate geriatric care has intensified. Humanized nursing emphasizes empathy and person-centered care, while community-based nursing builds on local resources and networks to support health and well-being. Together, these approaches offer promising strategies for improving care for older adults. This integrative review explores the evolution, clinical contributions, and implementation barriers of these models. Methods: A comprehensive literature search was performed using PubMed, CINAHL, Scopus, and Web of Science, targeting peer-reviewed studies, including qualitative and quantitative studies published between 2010 and 2025, that involved adults aged 60 years and older. Inclusion criteria emphasized humanized and community-based nursing interventions while excluding non-nursing and pediatric-focused studies. Quality appraisal was performed using CASP and JBI checklists, and data were thematically synthesized. Results: Evidence indicates that these care models significantly improve functional independence and psychosocial well-being and reduce hospital readmissions. For instance, community-based care in Taiwan improved activities of daily living in dementia patients by 15%, while U.S.-based programs reduced depressive symptoms by 30% among Latino older adults. Interdisciplinary, nurse-led interventions in South Korea and Puerto Rico showed a 22% reduction in readmissions and an 85% increase in care access. Despite these benefits, numerous barriers hinder widespread implementation, including workforce shortages, inadequate funding, fragmented healthcare systems, cultural resistance, digital literacy challenges, and policy constraints, particularly in low-resource settings such as the Philippines and Nepal. Conclusions: These findings underscore the transformative potential of humanized and community-based nursing while highlighting the need for targeted strategies such as task-shifting, inclusive technologies, and policy reform to advance equitable, sustainable geriatric care globally. Full article

Background/Objectives: Hypodermoclysis has gained increasing recognition as a safe, effective, and minimally invasive method for administering medication and fluids in palliative care. Despite its advantages, its adoption remains limited, primarily due to a lack of structured training resources for healthcare professionals. This study aimed to develop and validate an educational tool for training clinical nurses in hypodermoclysis administration in palliative care. Methods: This is a methodological study with a multi-methods approach. Study development involved a needs assessment with 48 professionals, a literature review, and the creation of a manual enriched with visual aids. Results: The material was validated by expert judges, technical reviewers, and the target audience. Organized into 21 chapters, the manual comprehensively addresses technical, theoretical, and ethical dimensions of the practice. Content validation by 14 experts yielded an outstanding global Content Validity Index (CVI) of 0.95. An independent evaluation of visual design by four communication specialists produced consistently high scores (91–96%), classifying the material as “superior” in quality. Feedback from target users (12 nurses) highlighted the manual’s clarity, applicability, and relevance. All constructive suggestions were incorporated into the final version. Conclusions: The resulting manual demonstrates strong validity as an educational resource, with significant potential to standardize and enhance hypodermoclysis training in palliative nursing, promoting both safety and humanized care. Full article

Objectives: This cross-sectional, descriptive correlational research investigated the relationship between stress, academic motivation, and subjective vitality among nursing students. Methods: Participants were recruited through a non-probability purposive sampling approach. An anonymous online survey was conducted with 188 first- to fourth-year study nursing students, assessing their perceived academic stress using the Perceptions of Academic Stress Scale, academic motivation using the Student Academic Motivation Scale (SAMS-21), and subjective vitality using the Subjective Vitality Scale. Descriptive statistics, bivariate correlational analysis, and multivariate analysis were employed in this study. Results: The results indicate that students experience moderate stress levels during exam sessions, with higher stress associated with workload and examinations. Academic motivation was characterized by high extrinsic motivation, which identified regulation and intrinsic motivation to know. A significant difference in a form of extrinsic motivation—introjected regulation—was found between student groups, with a tendency for this motivation to decrease over the years of study. No statistically significant relationship was found between students’ academic stress and subjective vitality. Conclusions: Academic stress related to workload and exams is determined by both demographic factors, such as age and year of study, and psychological factors, including academic self-perception and amotivation, which highlight the multifaceted nature of the stress experienced by nursing students. Students’ subjective vitality is related to intrinsic motivation—to know and achieve—and to all extrinsic motivation. External forms of regulation, especially introjected regulation, are significantly related to students’ subjective vitality. Full article

Background: In an increasingly globalized context marked by growing professional mobility, establishing shared standards for assessing nursing competencies is essential. The licensure examination represents a critical gateway between academic preparation and professional practice. However, significant ambiguity remains regarding what competencies are assessed and how this assessment is conducted internationally. Objective: This scoping review aimed to map the international literature on nursing licensure examinations by comparing frameworks and domains, performance levels, and assessment tools to identify similarities and differences in the core competencies required for entry into practice. Methods: The review followed Arksey and O’Malley’s methodological framework. Comprehensive searches were conducted across PubMed, CINAHL, Scopus, ERIC, Cochrane Library, ProQuest, and OpenGrey databases. Studies addressing competency frameworks, performance levels, and assessment tools in undergraduate nursing licensure were included. Results: Twenty-three studies were analyzed. The most frequently cited framework was ‘Client Needs’. Competency domains commonly addressed patient needs, professional roles, and healthcare settings. The dominant performance level was cognitive, typically assessed through multiple-choice questions; practical skills were often evaluated via ‘bedside tests’. Despite variations in frameworks and domains, cognitive performance expectations and assessment tools showed some consistency. Conclusions: These findings underscore the need for a context-sensitive, internationally adaptable framework to promote fairness and support nurse mobility. Full article

Background/Objectives: Missed nursing care—defined as any aspect of required patient care that is omitted or delayed—has emerged as a significant indicator of healthcare quality. Fatigue among nurses, particularly in high-demand environments, may contribute to care omissions. This study aimed to assess the prevalence and patterns of missed nursing care and its association with occupational fatigue among nurses working in Saudi hospitals. Methods: A cross-sectional correlational study was conducted among 183 registered nurses from multiple hospitals in the Hail and Madinah regions, Saudi Arabia. Data were collected using the Missed Nursing Care Scale (MISSCARE) and the Occupational Fatigue Exhaustion/Recovery Scale (OFER-15). Statistical analysis was performed to assess the relationships between missed care, fatigue, and demographic/work-related variables. Results: Nurses reported moderate levels of missed care, especially in basic care tasks such as oral hygiene, assistance with meals, and timely ambulation. The most frequently cited causes of missed care included insufficient staffing, high patient load, and a lack of support personnel. Occupational fatigue scores were also moderate, with notably low inter-shift recovery. A significant negative correlation was found between inter-shift recovery and missed care (r = −0.120, 95% CI: −0.23 to −0.005, p = 0.040), indicating that poorer recovery between shifts was associated with more frequent omissions. Other fatigue dimensions showed weak, non-significant associations with missed care. Conclusions: Missed nursing care is a prevalent issue in Saudi hospitals and is significantly influenced by organizational factors and nurses’ recovery between shifts. Interventions to improve staffing adequacy and promote rest and recovery may reduce care omissions and enhance patient outcomes. Full article

Background: Genomic information is becoming integral to nursing practice, yet undergraduate curricula often provide limited opportunities to apply this knowledge in realistic settings. Objective: To evaluate the impact of a clinical simulation-based intervention on nursing students’ learning of genetic counseling, with a focus on knowledge acquisition, communication skills, and student satisfaction. Methods: A sequential mixed-methods study was conducted with 30 third-year nursing students enrolled in the elective Genetics Applied to Health Sciences. Quantitative data comprised (i) pre-/post-simulation knowledge tests, (ii) a satisfaction questionnaire, and (iii) final course grades, which were compared with grades of a cohort from the previous academic year that had no simulation component (n = 28). Qualitative insights were gathered through field notes and semi-structured interviews with six purposively selected participants. During the intervention each student rotated through the roles of genetic-counseling nurse, patient, and observer, followed by a facilitated debriefing. Results: Post-simulation knowledge scores and final course grades were significantly higher than both baseline values and the historical comparison cohort. Students reported very high satisfaction, highlighting the authenticity of the scenarios and the usefulness of immediate feedback. Qualitative analysis showed that role rotation fostered deeper understanding of counseling complexities, improved empathic communication, and bolstered self-confidence when discussing hereditary risk. Conclusions: Embedding standardized-patient simulation into undergraduate genetics courses measurably improves students’ knowledge, communication proficiency, and satisfaction. These findings support incorporating similar simulation-based learning activities to bridge the gap between theoretical genetics content and real-world nursing practice. Full article

Background/Objectives: Missed nursing care (MNC), defined as any omitted or delayed aspect of required patient care, is a global concern affecting both patient outcomes and nurse well-being. In Saudi Arabia, few studies have examined its relationship with job satisfaction. This study assessed the prevalence of MNC, job satisfaction, and their association among nurses in government hospitals. Methods: A correlational, cross-sectional study was conducted between February and May 2025 in government hospitals across Albahah, Hail, and Almadina. A total of 366 registered nurses participated. Data were collected via a structured online questionnaire including demographic information, the Missed Nursing Care Scale, and the Minnesota Satisfaction Questionnaire (MSQ). Data were analyzed using descriptive statistics, Spearman’s correlation, and regression analysis. Results: Basic care activities such as mouth care, bathing, and meal assistance were the most frequently missed tasks, mainly due to staffing shortages and high patient loads. The median MSQ score was 60 (44–71 Interquartile Range), reflecting moderate job satisfaction. A significant negative correlation was observed between MNC and job satisfaction (r = −0.267, p < 0.001), indicating that increased missed care was associated with lower satisfaction levels. Conclusions: The findings highlight the urgent need for healthcare administrators and policymakers to implement strategies to improve staffing levels and work environments. Addressing these organizational factors is essential to reducing missed nursing care, enhancing nurse job satisfaction, and ultimately improving patient safety and care quality in Saudi government hospitals. Full article

Background: The U.S. Medicare Annual Wellness Visit (AWV) offers a structured opportunity for cognitive screening and personalized prevention planning among older adults. Yet, implementation of AWVs, particularly for individuals with cognitive impairment, remains inconsistent across primary care or other diverse care settings. Methods: We conducted a scoping review using the Consolidated Framework for Implementation Research (CFIR) to explore multilevel factors influencing the implementation of the Medicare AWV’s cognitive screening component, with a focus on how these processes support the detection and management of cognitive impairment among older adults. We searched four databases and screened peer-reviewed studies published between 2011 and March 2025. Searches were conducted in Ovid MEDLINE, PubMed, EBSCOhost, and CINAHL databases. The initial search was completed on 3 January 2024 and updated monthly through 30 March 2025. All retrieved citations were imported into EndNote 21, where duplicates were removed. We screened titles and abstracts for relevance using the predefined inclusion criteria. Full-text articles were then reviewed and scored as either relevant (1) or not relevant (0). Discrepancies were resolved through consensus discussions. To assess the methodological quality of the included studies, we used the Joanna Briggs Institute critical appraisal tools appropriate to each study design. These tools evaluate rigor, trustworthiness, relevance, and risk of bias. We extracted the following data from each included study: Author(s), year, title, and journal; Study type and design; Data collection methods and setting; Sample size and population characteristics; Outcome measures; Intervention details (AWV delivery context); and Reported facilitators, barriers, and outcomes related to AWV implementation. The first two authors independently coded and synthesized all relevant data using a table created in Microsoft Excel. The CFIR guided our data analysis, thematizing our findings into facilitators and barriers across its five domains, viz: (1) Intervention Characteristics, (2) Outer Setting, (3) Inner Setting, (4) Characteristics of Individuals, and (5) Implementation Process. Results: Among 19 included studies, most used quantitative designs and secondary data. Our CFIR-based synthesis revealed that AWV implementation is shaped by interdependent factors across five domains. Key facilitators included AWV adaptability, Electronic Health Record (EHR) integration, team-based workflows, policy alignment (e.g., Accountable Care Organization participation), and provider confidence. Barriers included vague Centers for Medicare and Medicaid Services (CMS) guidance, limited reimbursement, staffing shortages, workflow misalignment, and provider discomfort with cognitive screening. Implementation strategies were often poorly defined or inconsistently applied. Conclusions: Effective AWV delivery for older adults with cognitive impairment requires more than sound policy and intervention design; it demands organizational readiness, structured implementation, and engaged providers. Tailored training, leadership support, and integrated infrastructure are essential. These insights are relevant not only for U.S. Medicare but also for global efforts to integrate dementia-sensitive care into primary health systems. Our study has a few limitations that should be acknowledged. First, our scoping review synthesized findings predominantly from quantitative studies, with only two mixed-method studies and no studies using strictly qualitative methodologies. Second, few studies disaggregated findings by race, ethnicity, or geography, reducing our ability to assess equity-related outcomes. Moreover, few studies provided sufficient detail on the specific cognitive screening instruments used or on the scope and delivery of educational materials for patients and caregivers, limiting generalizability and implementation insights. Third, grey literature and non-peer-reviewed sources were not included. Fourth, although CFIR provided a comprehensive analytic structure, some studies did not explicitly fit in with our implementation frameworks, which required subjective mapping of findings to CFIR domains and may have introduced classification bias. Additionally, although our review did not quantitatively stratify findings by year, we observed that studies from more recent years were more likely to emphasize implementation facilitators (e.g., use of templates, workflow integration), whereas earlier studies often highlighted systemic barriers such as time constraints and provider unfamiliarity with AWV components. Finally, while our review focused specifically on AWV implementation in the United States, we recognize the value of comparative analysis with international contexts. This work was supported by a grant from the National Institute on Aging, National Institutes of Health (Grant No. 1R01AG083102-01; PIs: Tzeng, Kuo, & Raji). Full article

Aim: The purpose of this study was to explore the broad experience of continuous glucose monitoring from the perspective of patients diagnosed with type 1 diabetes mellitus, including not only their emotions and feelings but also the lifestyle changes, perceptions, and social aspects associated with its use. Design: This is a phenomenological qualitative study. Patient or Public Contribution: The sample consisted of 10 adult patients diagnosed with type 1 diabetes who had been using the continuous glucose monitoring system for at least 6 months and were patients of the Endocrinology and Nutrition Service of the University Hospital Complex of Ourense. Methods: The recorded interviews were conducted in November 2024. The conversations were audio-recorded with the participants’ consent, and then transcribed for thematic analysis. Results: Three main categories were identified: “experience prior to continuous glucose monitoring” (accessibility, prior knowledge, and expectations), “experience with the use of continuous glucose monitoring” (perception of healthcare support, concerns, strengths, and alarm management), and “experience regarding the disease” (self-management of the disease and safety). Despite the fact that diabetes mellitus is a complex chronic disease, all participants provided a positive assessment of their progress and improved control through continuous glucose monitoring. Conclusions: All participants felt more secure and protected with continuous glucose monitoring, improving their quality of life. The main concern among the subjects was the possibility of the sensor failing. They positively valued the alarm system in case of hypoglycemia. The CGM is a highly effective tool for the management and self-control of diabetes and promotes the relationship between patients and professional health. Impact: The findings of this study have important implications for clinical care, highlighting the need for more training and more health education at the first level of health care, such as health centers. Full article

Background/Objectives: Private hosting arrangements have emerged as community-driven alternatives to institutional refugee housing, offering personalized support and opportunities for enhanced social integration. However, clarity around care practices and service delivery models remains underdeveloped. Methods: This paper presents the findings of a scoping review aimed at mapping evidence on service delivery and care practices in private hosting contexts for refugee families. Following an overview of the background and methodology, we present key themes, propose a conceptual model, and conclude with implications for policy, practice, and future research. This scoping review maps existing literature on care practices; it does not assess the effectiveness of interventions or establish best practices. The review synthesizes empirical and gray literature on service delivery and care practices supporting refugee and displaced families in private hosting contexts. Following the Joanna Briggs Institute (JBI) methodology, six academic databases and multiple gray literature sources were systematically searched, resulting in the inclusion of 28 studies. Results: The analysis identified four conceptual dimensions of care described in the literature: relational care and trust-building, program structure and policy integration, holistic integration pathways, and embedded equity and protection. While private hosting facilitates emotional connection and psychosocial integration, the review highlights key challenges, including variability in host preparedness, emotional labor disparities, and limited formal oversight. Conclusions: The findings underscore the need for evidence-informed guidelines, standardized host training, trauma-informed approaches, and coordinated policy frameworks. The resulting model offers a foundation to inform future research, guide policy development, and strengthen private hosting practices to ensure equitable, inclusive, and sustainable outcomes for refugee and displaced families. Full article

Background/Objectives: Capnography monitoring in the Post-Anesthesia Care Unit (PACU) plays a crucial role in the early detection of respiratory complications, being fundamental for patient safety. It provides objective and continuous data on ventilation, enabling timely interventions to optimize health outcomes. This scoping review aims to map the available evidence regarding barriers and facilitators to the use of capnography for respiratory monitoring by nurses in the Phase I PACU. Methods: A scoping review was conducted following the methodology proposed by the Joanna Briggs Institute (JBI). The search was performed in the MEDLINE and CINAHL Complete databases and the Portuguese Open Access Scientific Repository (RCAAP). Studies in Portuguese, English, and Spanish were included, with no time restrictions. The search strategy combined indexing terms and natural language, adapted to each database. Results: Seven studies were included in the sample. The main identified barriers were a high workload, perceived lack of patient adherence, and lack of knowledge. Key facilitators included the alarm sound, patient education, anticipating patient clinical instability, increased nurse confidence, perception of enhanced safety, targeted training for nurses, continuous improvement in care delivery, effective communication and feedback, promotion of sustainable care practices, and prior knowledge and exposure. Conclusions: The use of capnography in the PACU allows for respiratory function assessment and the early detection of clinical events. Its implementation should be based on current scientific evidence, promoting a culture of safety and quality improvement in patient care. Full article

Nurse practitioners (NPs) are increasingly integrated into surgical care teams, complementing traditional surgical roles. However, the relationship between their involvement and patient-reported outcome measures (PROMs), such as pain and anxiety, remains understudied. Purpose: To examine the types of care from NPs in surgical units during the perioperative period and evaluate their association with length of stay, pain, and anxiety. Methods: Our prospective comparative study in two surgical units at a tertiary medical center included 315 patients: 156 received care from NPs, and 159 received usual care. Data were collected at three time points: post-operative day one (T0), during hospitalization (T1), and 14 days post-discharge (T2). Measures included the Brief Pain Inventory, the Hospital Anxiety and Depression Scale, and an intervention checklist completed by the NPs. Findings: NPs performed primarily in-hospital interventions including care coordination (40%) and medication management (44%). Patients treated by NPs reported significantly lower in-hospital anxiety compared to usual care (p = 0.001). The length of stay and pain levels were not significantly associated with NP care. Discussion: NPs in surgical settings provide patient-centered care associated with lower in-hospital anxiety. Further research is recommended to validate these findings in diverse settings. Full article

Introduction: Pain represents a significant threat to the physical and psychological well-being of children, negatively affecting their quality of life during hospitalization. Pain is considered the fifth vital sign and must be regularly assessed and managed, as also emphasized by the nursing code of ethics. The interdisciplinary approach to pediatric pain management includes both pharmacological treatments and non-pharmacological techniques (NPTs), taking into account the child’s age and specific needs. NPTs comprise a broad set of methods, ranging from simple to complex, that can be applied to children to help them manage pain. The main objective of this study was to explore and analyze which non-pharmacological methods are adopted by nurses in their clinical practice to relieve pain in school-aged children (6–12 years) undergoing surgery. Materials and Methods: This observational study involved nursing staff from pediatric wards in the Italian provinces of Ravenna, Forlì-Cesena, and Rimini, and used a validated online questionnaire. The study focused on school-aged children (6–12 years) who had undergone surgical procedures. The questionnaire included items on which NPTs nurses used to relieve pain in pediatric patients. Participants responded using a Likert scale from 1 (never) to 5 (always), and anonymity and voluntary participation were guaranteed. Data were collected between February and October 2024, involving the pediatric units of three hospitals in the provinces of Ravenna, Forlì-Cesena, and Rimini. Statistical analyses included t-tests, ANOVA, and Kruskal–Wallis tests to identify significant differences. Results: A total of 46 nurses completed the questionnaire. No significant differences were found between nurses’ backgrounds and the use of NPTs. Overall, nurses did report using NPTs, although there was limited use of such techniques in the preoperative phase. The study also highlighted a discrepancy in the information provided to children versus parents, with nurses tending to give more information to parents during the preoperative period. Notably, nurses who reported effective multidisciplinary collaboration were also those who better prepared children using NPTs. Conclusions: This study emphasizes the importance of NPTs in pediatric pain management and highlights the need to improve direct communication with children. Adopting an effective multidisciplinary approach is essential to ensuring a less traumatic surgical experience for young patients. Full article

Background: In health sciences education and particularly, in healthcare education, nursing education, and medical education, augmented reality is being increasingly used due to the changes and benefits to teaching and learning approaches it can yield. However, as the field advances, it is important to systematically map the current literature and provide an overview of the field. Aim: By analyzing the current literature, this study focuses on examining the use of augmented reality in healthcare, nursing, and medical education and training. Method: The study adopts a systematic mapping review approach and analyzes 156 studies that were published during 2010–2025. Results: The results revealed that augmented reality is an effective educational tool that can support teaching and learning of diverse subjects in the context of health education, as it enables learners to combine their theoretical knowledge with practical applications within interactive and immersive learning environments and simulations without risking patient safety. Increased learning outcomes, including hands-on acquisition of practical skills and clinical competencies, engagement, performance, knowledge gain and retention, as well as their critical thinking and decision-making were observed. The potential of augmented reality to offer realistic and interactive visual representations, to support procedural training, to provide cost-effective solutions, to enhance collaborative learning, and to increase accessibility to education, even in resource-limited settings, was highlighted. Education stakeholders expressed positive attitudes and perspectives toward the adoption and integration of augmented reality into health sciences education. Discussion: The results emphasize the role of augmented reality in supporting and improving health education. Additionally, the study revealed six main topics, identified current research gaps, and provided future research directions. Conclusions: When appropriately applied, augmented reality has the potential to effectively support and enrich nursing, healthcare, and medical education and training. Full article

Background: Nursing students often face high academic and emotional demands, which can negatively affect both their mental health and academic performance. From a salutogenic perspective, the sense of coherence (SOC) is considered a key protective factor in managing stress and fostering resilience. Objectives: This study aimed to explore the SOC levels among nursing students and examine their associations with perceived academic stress and sociodemographic variables. Methods: A multicenter, cross-sectional, exploratory study was conducted in a sample of 1301 undergraduate nursing students from four universities in Spain and Chile. Participants completed the Orientation to Life Questionnaire, a validated instrument assessing SOC and its three dimensions: comprehensibility, manageability, and meaningfulness. Sociodemographic data and students’ perceived stress in relation to key academic activities were also collected. Descriptive and inferential statistical analyses were performed, including t-tests and ANOVA. Results: The mean SOC score was 62.65 (SD = 12.36), with no significant differences between universities. Significant associations (p < 0.05) were found between SOC scores and age, marital status, academic year, work status, and university entry path, but not with gender or caregiving responsibilities. Students aged ≥29 years and those who were married or working had higher SOC scores. Higher levels of perceived stress in lectures, seminars, clinical practice, group work, and written assignments were significantly associated with lower SOC scores. Conclusions: This study’s findings suggest that a stronger SOC is associated with lower perceived academic stress and certain sociodemographic characteristics. Integrating salutogenic approaches into nursing curricula could strengthen students’ SOC, promoting their mental well-being and academic resilience. Full article

Background/Objectives: Men have historically contributed significantly to mental health nursing, particularly in inpatient settings, where their presence has supported patient recovery and safety. Despite this legacy, men remain under-represented in the nursing workforce, and addressing this imbalance is critical to workforce sustainability. This study offers a novel contribution by exploring the lived experiences, motivations, and professional identities of men in mental health nursing, an area that has received limited empirical attention. The aim of the study is to examine the characteristics, qualities, and attributes of mental health nurses who are male, which contributes to their attraction to and retention within the profession. Methods: A qualitative interpretive inquiry was conducted among nurses who were male and either currently or previously employed in mental health settings. Two focus groups were conducted using semi-structured questions to explore their career pathways, motivations, professional identities, and perceived contributions. Thematic analysis was used to identify key themes and patterns in their narratives. Results: Seven participants, with 10–30 years of experience, participated. They had entered the profession through diverse pathways, expressing strong alignment between personal values and professional roles. Five themes emerged and centred on mental health being the heart of health, personal and professional fulfillment, camaraderie and teamwork, a profound respect for individuals and compassion, and overcoming and enjoying the challenge. Conclusions: Mental health nurses who are male bring unique contributions to the profession, embodying compassion, resilience, and ethical advocacy. Their experiences challenge traditional gender norms and redefine masculinity in health care. Fostering inclusive environments, mentorship, and leadership opportunities is essential to support their growth. These insights inform strategies to strengthen recruitment, retention, and the future of mental health nursing. Full article

Background/Objective: Nursing and non-nursing students experience high stress levels, making them susceptible to mental health issues. This study compared stress, anxiety, and depression between these two groups after 2 years of the COVID-19 pandemic. Additionally, it explored the relationship between perceived helplessness, self-efficacy, and symptoms of mental stress and strain resulting from challenging internship conditions for nursing students. Methods: This cross-sectional study included 154 nursing students (mean age = 22.43 years) and 291 non-nursing students (mean age = 27.7 years). Data were collected using the Depression Anxiety Stress Scales (DASS-21), Perceived Stress Scale-10 (PSS-10), and a questionnaire on mental stress and strain. Results: Nursing students reported significantly higher scores in the DASS-21 subscales depression (ηp² = 0.016) and anxiety (ηp² = 0.037), and global stress (PSS-10; ηp² = 0.029) compared to non-nursing students, but no significant difference on the DASS-21 Stress subscale. The observed group differences in the present study may be partially attributed to group differences in demographic factors. Helplessness correlated strongly with nearly all scales of mental stress and strain during internships (all p’s < 0.001), while self-efficacy showed a strong negative correlation with non-occupational difficulties, health impairment, and emotional problems (all p’s < 0.001). Conclusions: Nursing students experience elevated depression, anxiety, and perceived stress levels compared to non-nursing students. Stronger feelings of helplessness and lower confidence in their ability to overcome challenges were strongly correlated with mental stress and strain during clinical training. Targeted interventions such as cognitive behavioral training and stress management should be integrated into nursing curricula to enhance resilience and coping strategies. Full article

Background/Objectives: The transformation of nursing and midwifery education through digital technologies has gained momentum worldwide, with algorithm-based video instruction and virtual reality (VR) emerging as promising tools for improving clinical learning. This quasi-experimental study explores the impact of an enhanced flipped classroom model on Bulgarian nursing and midwifery students’ self-perceived competence. Methods: A total of 228 participants were divided into a control group receiving traditional instruction (lectures and simulations with manikins) and an experimental group engaged in a digitally enhanced preparatory phase. The latter included pre-class video algorithms, VR, and clinical problem-solving tasks for learning and improving nursing skills. A 25-item self-report questionnaire was administered before and after the intervention to measure perceived competence in injection techniques, hygiene care, midwifery skills, and digital readiness. Results: Statistical analysis using Welch’s t-test revealed significant improvements in the experimental group in all domains (p < 0.001). Qualitative data from focus group interviews further confirmed increased student engagement, motivation, and receptiveness to digital learning tools. Conclusions: The findings highlight the pedagogical value of integrating structured video learning, VR components, and case-based learning within flipped classrooms. The study advocates for the wider adoption of blended learning models to foster clinical confidence and digital competence in healthcare education. The results of the study may be useful for curriculum developers aiming to improve clinical readiness through technology-enhanced learning. Full article

Background: The progression of Alzheimer’s Disease (AD) deeply affects not only the diagnosed person but also their close relatives, who are often called to take on the role of informal caregivers. This transition is frequently unplanned and emotionally complex, yet poorly understood in its deeper processual dimensions. This study aims to explore and theorize the transition experienced by a family member becoming the primary informal caregiver for a person with advanced AD. Methods: A qualitative study based on the Constructivist Grounded Theory according to Charmaz’s approach (2006) was conducted. In-depth interviews were carried out with 10 participants who had become informal caregivers for a loved one with advanced AD. Data were analyzed using initial coding, focused coding, the constant comparative method, and theoretical coding. Results: Ten caregivers (mean age 39 years, range 35–54; nine females) of patients with advanced AD participated in the study. The analysis revealed a complex, emotionally intense caregiving experience marked by sacrifice, feelings of powerlessness, identity loss, and the necessity of sharing caregiving responsibilities. A core category emerged: A Silent and Certain Willingness to Care, representing the caregivers’ deep, often unconscious commitment to prioritize the care of their loved ones above their own needs. Four interconnected phases characterized the caregiving process: (1) The Changing Daily Life—involving significant sacrifices in personal and social life; (2) Feeling Powerless—confronting the inevitable decline without means to alter the course; (3) Losing Oneself—experiencing physical and psychological exhaustion and a sense of identity loss; and (4) Sharing with Others—seeking external support to sustain caregiving. These findings highlight the evolving nature of becoming a caregiver and the enduring dedication that sustains this role despite the challenges. Conclusions: The progression of AD deeply transforms the lives of caregivers, who become co-sufferers and active participants in the disease’s management. The results underscore the urgency of designing integrative care strategies—including psychological, social, and potentially technological support—that can enhance both patient outcomes and caregiver resilience. Grounded in real-world experiences, this study contributes to the broader neurodegeneration discourse by emphasizing caregiving as a critical factor in long-term disease management and therapeutic success. Full article

Background and Aim: Artificial intelligence (AI) is among the most promising innovations for transforming nursing education, making it more interactive, personalized, and competency-based. However, its integration also raises significant ethical and practical concerns. This scoping review aims to analyze and summarize key studies on the application of AI in university-level nursing education, focusing on its benefits, challenges, and future prospects. Methods: A scoping review was conducted using the Population, Concept, and Context (PCC) framework, targeting nursing students and educators in academic settings. A comprehensive search was carried out across the PubMed, Scopus, and Web of Science databases. Only peer-reviewed original studies published in English were included. Two researchers independently screened the studies, resolving any disagreements through team discussion. Data were synthesized narratively. Results: Of the 569 articles initially identified, 11 original studies met the inclusion criteria. The findings indicate that AI-based tools—such as virtual simulators and ChatGPT—can enhance students’ learning experiences, communication skills, and clinical preparedness. Nonetheless, several challenges were identified, including increased simulation-related anxiety, potential misuse, and ethical concerns related to data quality, privacy, and academic integrity. Conclusions: AI offers significant opportunities to enhance nursing education; however, its implementation must be approached with critical awareness and responsibility. It is essential that students develop both digital competencies and ethical sensitivity to fully leverage AI’s potential while ensuring high-quality education and responsible nursing practice. Full article

Background/Objectives: Anxiety before ophthalmic surgery under local anesthesia may hinder patient cooperation and surgical outcomes. Nurse-led auditory interventions offer a promising non-pharmacological approach to perioperative anxiety management. This study evaluated the effectiveness of superimposed binaural beats (SBBs)—classical music layered with frequency differentials—in reducing anxiety during pterygium surgery with conjunctival autografting. Methods: In this randomized controlled trial, 111 adult patients scheduled for elective pterygium excision with conjunctival autografting under local anesthesia were allocated to one of three groups: SBBs, plain music (PM), or silence (control). A trained perioperative nurse administered all auditory interventions. The patients’ anxiety was assessed using the State–Trait Anxiety Inventory—State (STAI-S), and physiological parameters (blood pressure, heart rate, respiratory rate, and oxygen saturation) were recorded before and after surgery. Results: The SBB group showed significantly greater reductions in their STAI-S scores (p < 0.001), systolic blood pressure (p = 0.011), heart rate (p = 0.003), and respiratory rate (p = 0.009) compared to the PM and control groups. No adverse events occurred. Conclusions: SBBs are a safe, nurse-delivered auditory intervention that significantly reduces perioperative anxiety and supports physiological stability. Their integration into routine nursing care for minor ophthalmic surgeries is both feasible and beneficial. Trial Registration: This study was registered with the Thai Clinical Trials Registry (TCTR) under registration number TCTR20250125002 on 25 January 2025. Full article

Background: Artificial intelligence (AI) and machine learning (ML) have been reshaping maternal, fetal, neonatal, and reproductive healthcare by enhancing risk prediction, diagnostic accuracy, and operational efficiency across the perinatal continuum. However, no comprehensive synthesis has yet been published. Objective: To conduct a scoping review of reviews of AI/ML applications spanning reproductive, prenatal, postpartum, neonatal, and early child-development care. Methods: We searched PubMed, Embase, the Cochrane Library, Web of Science, and Scopus through April 2025. Two reviewers independently screened records, extracted data, and assessed methodological quality using AMSTAR 2 for systematic reviews, ROBIS for bias assessment, SANRA for narrative reviews, and JBI guidance for scoping reviews. Results: Thirty-nine reviews met our inclusion criteria. In preconception and fertility treatment, convolutional neural network-based platforms can identify viable embryos and key sperm parameters with over 90 percent accuracy, and machine-learning models can personalize follicle-stimulating hormone regimens to boost mature oocyte yield while reducing overall medication use. Digital sexual-health chatbots have enhanced patient education, pre-exposure prophylaxis adherence, and safer sexual behaviors, although data-privacy safeguards and bias mitigation remain priorities. During pregnancy, advanced deep-learning models can segment fetal anatomy on ultrasound images with more than 90 percent overlap compared to expert annotations and can detect anomalies with sensitivity exceeding 93 percent. Predictive biometric tools can estimate gestational age within one week with accuracy and fetal weight within approximately 190 g. In the postpartum period, AI-driven decision-support systems and conversational agents can facilitate early screening for depression and can guide follow-up care. Wearable sensors enable remote monitoring of maternal blood pressure and heart rate to support timely clinical intervention. Within neonatal care, the Heart Rate Observation (HeRO) system has reduced mortality among very low-birth-weight infants by roughly 20 percent, and additional AI models can predict neonatal sepsis, retinopathy of prematurity, and necrotizing enterocolitis with area-under-the-curve values above 0.80. From an operational standpoint, automated ultrasound workflows deliver biometric measurements at about 14 milliseconds per frame, and dynamic scheduling in IVF laboratories lowers staff workload and per-cycle costs. Home-monitoring platforms for pregnant women are associated with 7–11 percent reductions in maternal mortality and preeclampsia incidence. Despite these advances, most evidence derives from retrospective, single-center studies with limited external validation. Low-resource settings, especially in Sub-Saharan Africa, remain under-represented, and few AI solutions are fully embedded in electronic health records. Conclusions: AI holds transformative promise for perinatal care but will require prospective multicenter validation, equity-centered design, robust governance, transparent fairness audits, and seamless electronic health record integration to translate these innovations into routine practice and improve maternal and neonatal outcomes. Full article

Background/Objectives: The integration of AI chatbots in nursing education, particularly in simulation-based learning, is advancing rapidly. However, there is a lack of structured evaluation models, especially to assess AI-generated simulations. This article introduces the AI-Integrated Method for Simulation (AIMS) evaluation framework, a dual-phase evaluation framework adapted from the FAITA model, designed to evaluate both prompt design and chatbot performance in the context of nursing education. Methods: This simulation-based study explored the application of an AI chatbot in an emergency planning course. The AIMS framework was developed and applied, consisting of six prompt-level domains (Phase 1) and eight performance criteria (Phase 2). These domains were selected based on current best practices in instructional design, simulation fidelity, and emerging AI evaluation literature. To assess the chatbots educational utility, the study employed a scoring rubric for each phase and incorporated a structured feedback loop to refine both prompt design and chatbox interaction. To demonstrate the framework’s practical application, the researchers configured an AI tool referred to in this study as “Eval-Bot v1”, built using OpenAI’s GPT-4.0, to apply Phase 1 scoring criteria to a real simulation prompt. Insights from this analysis were then used to anticipate Phase 2 performance and identify areas for improvement. Participants (three individuals)—all experienced healthcare educators and advanced practice nurses with expertise in clinical decision-making and simulation-based teaching—reviewed the prompt and Eval-Bot’s score to triangulate findings. Results: Simulated evaluations revealed clear strengths in the prompt alignment with course objectives and its capacity to foster interactive learning. Participants noted that the AI chatbot supported engagement and maintained appropriate pacing, particularly in scenarios involving emergency planning decision-making. However, challenges emerged in areas related to personalization and inclusivity. While the chatbot responded consistently to general queries, it struggled to adapt tone, complexity and content to reflect diverse learner needs or cultural nuances. To support replication and refinement, a sample scoring rubric and simulation prompt template are provided. When evaluated using the Eval-Bot tool, moderate concerns were flagged regarding safety prompts and inclusive language, particularly in how the chatbot navigated sensitive decision points. These gaps were linked to predicted performance issues in Phase 2 domains such as dialog control, equity, and user reassurance. Based on these findings, revised prompt strategies were developed to improve contextual sensitivity, promote inclusivity, and strengthen ethical guidance within chatbot-led simulations. Conclusions: The AIMS evaluation framework provides a practical and replicable approach for evaluating the use of AI chatbots in simulation-based education. By offering structured criteria for both prompt design and chatbot performance, the model supports instructional designers, simulation specialists, and developers in identifying areas of strength and improvement. The findings underscore the importance of intentional design, safety monitoring, and inclusive language when integrating AI into nursing and health education. As AI tools become more embedded in learning environments, this framework offers a thoughtful starting point for ensuring they are applied ethically, effectively, and with learner diversity in mind. Full article

Purpose: Exercise is recommended for survivors of breast cancer to alleviate adverse reactions and reduce the psychological burden. In recent years, however, environmental factors (e.g., pandemics and climate change) have made it difficult to exercise outdoors. Therefore, this study focused on the COVID-19 pandemic in Japan and evaluated the relationship between changes in physical activity (PA) and mental and physical health in breast cancer survivors. Methods: A questionnaire survey was conducted among 345 outpatient female breast cancer survivors aged between 29 and 69 years. The questionnaire was based on the International Physical Activity Questionnaire, the Patient Health Questionnaire-9, the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire, and the Fear of COVID-19 Scale and included patient characteristics, changes in PA during pandemic restrictions, and needs for exercise support. The analysis categorized PA changes into two groups according to activity levels. The relationship between changes in PA and physical and mental health was evaluated using logistic regression analysis. Results: Patients with decreased PA accounted for 65.5% of the study population. Regardless of their activity level, these patients were aware of an increased susceptibility to COVID-19, showed a fear of the disease and a tendency for depression, and reported low life satisfaction and declined physical function. Of the patients who stopped exercising, 82.9% reported a decline in PA. Compared with those who had never exercised, those who stopped exercising saw their risk of depression increase by 15.6%. There was a high demand for personalized exercise support from healthcare professionals. Conclusions: Regardless of their activity level, decreasing PA during the pandemic decreased mental health and physical function in breast cancer survivors. There was a higher risk of depression among patients who stopped exercising. Because it is possible that similar situations may occur in the future, interventions by healthcare professionals must be considered in order to continue exercise. Full article