Nurs. Rep., Volume 15, Issue 9 (September 2025) – 27 articles

High attrition rates among nursing students, particularly during the sophomore year, threaten the sustainability of the nursing workforce. This study assessed structured assessment methods implemented at a School of Nursing located in northern Virginia to improve student success and reduce attrition. Interventions included a three-tier grading system (Mastery, Intermediate, and Novice), standardized rubrics, detailed instructor guidelines, remediation sessions, and medication competency practice materials. Data from student and instructor feedback surveys and attrition rate comparisons between Spring 2024 and Spring 2025 revealed a reduction in overall attrition of sophomores from 23.5% to 17.3% and from 20% to 12% in the Fundamentals courses. Students reported increased engagement and confidence in foundational core skills, though complex nursing skills care posed challenges. Instructors valued the structure but questioned the suitability of certain skills for sophomores. These findings underscore the value of structured assessments in enhancing retention, with implications for revision of curriculum design in students’ early years of nursing education. Full article

Background/Objectives: Caring–healing modalities (CHMs), i.e., non-pharmacological, nurse-led interventions rooted in caring science, have shown promise in reducing emotional distress, while enhancing resilience. CHMs are heterogeneous, making it challenging to determine how they are formulated to build resilience, mitigate emotional distress, and explore their mechanisms of action. This scoping review mapped the literature on CHMs, including their components, targeted outcomes, and measures. Methods: This review was conceptually driven by Watson’s Theory of Human Caring, followed the JBI methodology, and reported according to the PRISMA-ScR. Experimental studies, systematic reviews, opinion pieces, and the gray literature on CHMs for emotional distress and resilience delivered to persons with cancer, written in English, were considered. No date or setting limits were applied. Eleven databases (e.g., PubMed and CINAHL Full Text), were searched. Two independent reviewers screened, selected, and extracted the data. The results were interpreted using Watson’s theory. Results: We included 16 records (2016–2025), mostly from the United States (n = 4; 25%) and China (n = 6; 37.5%). The CHMs mainly targeted persons with breast cancer. The CHMs were categorized into four groups: mindfulness-based, group-based, expressive, and educational. Common active ingredients included peer support and group discussions. Dedicated healing spaces facilitated CHMs delivery; mode of delivery and dose varied widely. Conclusions: This review provides a foundational understanding of CHMs as a caring-based, holistic approach to cancer survivorship. Findings identify CHMs’ key components, including active ingredients, mode of delivery, and dose. Future studies should ensure diversity in terms of cancer type, as most existing studies focused on breast cancer. Full article

Background: Gamification may enhance engagement and higher-order learning in health-care profession education, but evidence from undergraduate nursing programs—particularly in the Middle East—is limited. We evaluated whether integrating structured gamified activities into an anatomy and physiology course improves class engagement and knowledge-based critical thinking. Methods: In this pragmatic, nonrandomized, section-allocated quasi-experimental study at a single Saudi institution, 121 first-year female nursing students were assigned by existing cohorts to traditional instruction (control; n = 61) or instruction enhanced with gamified elements (intervention; n = 60) groups. The intervention (introduced mid-semester) comprised time-limited competitive quizzing with immediate feedback and aligned puzzle tasks. Outcomes were measured at baseline, mid-semester, and end-semester using a four-item Class Engagement Rubric (CER; scale 1–5) and a 40-item high-cognitive multiple-choice (MCQ) assessment mapped to course objectives. Analyses used paired and independent t-tests with effect sizes and 95% confidence intervals. Results: No attrition occurred. From baseline to end-semester, the intervention group had a mean CER increase of 0.59 points (95% CI, 0.42 to 0.76; p < 0.001)—approximately a 15% relative gain—and a mean MCQ increase of 0.30 points (95% CI, 0.18 to 0.42; p < 0.001), an ~8% relative gain. The control group showed no material change over the same interval. Between-group differences in change favored the intervention across CER items and for the MCQ outcome. Semester grade-point average did not differ significantly between groups (p = 0.055). Conclusions: Embedding a brief, structured gamification package within an undergraduate nursing anatomy and physiology course was associated with measurable improvements in classroom engagement and modest gains in knowledge-based critical thinking, with no detectable effect on overall semester GPA. Given the nonrandomized, single-site design, causal inference is limited. Multi-site randomized trials using validated critical-thinking instruments are warranted to confirm effectiveness and define dose, durability, and generalizability. Full article

Background/Objectives: Patients receiving professional homecare often require support in managing their medication. In Switzerland’s legislative system, medication logistics (ordering, delivery, pickup, storage) are regulated differently by each canton, making it challenging for professional homecare organisations to comply with provisions efficiently. The present study aimed to analyse the current international literature, Switzerland’s regulations about medication logistics for professional homecare, and the current practices. Methods: We conducted a systematic literature review of the PubMed, Embase and CINAHL databases to identify existing international research on medication logistics by professional homecare organisations published until February 2024. The results of a structured online survey on medication logistics by professional homecare organisations in Switzerland’s German-speaking regions were compared against the medication regulations currently in place. Results: Ten studies were included in the review. The medication logistics processes of homecare organisations have rarely been researched, especially short-term and long-term storage. Few regulations cover medication logistics in Switzerland’s legislation, and they are often formulated non-specifically and focus on inpatient facilities. Some cantons allow centralised medication storage, others prohibit it. Only one canton explicitly permits short-term medication storage under simplified requirements. We evaluated the answers of 105 homecare organisations responding to our survey; 73.7% (73/99) of them nevertheless stored medications in the short term before bringing them to patients’ homes. Switzerland’s professional homecare organisations generally fulfil their legal requirements well. There is potential to improve the formulation of standard operating procedures for each step of the homecare medication use process, especially for cleaning medication storage sites (12/31, 38.7%) and short-term storage processes (29/56, 51.8%). Conclusions: There are few studies or guidelines on professional homecare organisations’ medication logistics, and they generally fail to address medication storage. Short-term medication storage is common despite most cantonal requirements being strict or prohibiting it, or not regulating it all. There is an urgent need for unambiguous, practice-oriented recommendations specific to homecare, especially for short-term medication storage. Full article

Background/Objectives: In recent years, the use of gamification has been growing in health education. In undergraduate nursing programs, it aims to enhance motivation, engagement, knowledge retention, and professional competencies. However, the evidence often combining nursing students with other disciplines or focusing on specific tools rather than the broader concept. This systematic review will synthesize the impact of gamification strategies on educational outcomes in undergraduate nursing education. Methods: This protocol was written according to PRISMA-P guidelines and is registered in PROSPERO (CRD420251117719). Eligible studies will include randomized controlled trials, quasi-experimental, and observational designs involving undergraduate nursing students exposed to gamification interventions in classroom, online, or clinical training settings. Comparators may include traditional lecture-based instruction or other non-gamified methods. We will search the PubMed, CINAHL, PsycINFO, Web of Science, Scopus, and Google Scholar databases, covering January 2010 to July 2025, without language restrictions. Two reviewers will independently screen studies, extract data, and assess risk of bias using Cochrane RoB-2, ROBINS-I, and JBI Critical Appraisal Tools. Where possible, a meta-analysis will be conducted; otherwise, findings will be synthesized narratively. Results: Not applicable; this is a protocol. Findings will be synthesized as specified in the Methods. Conclusions: This review will provide a comprehensive synthesis of gamification’s effectiveness in undergraduate nursing education, identifying the most effective strategies and the contexts in which they perform best. Full article

Background: Digital health literacy is crucial for navigating social media as a primary health information source. However, its interactive and unregulated nature fosters misinformation, requiring critical evaluation skills. Existing tools assess general internet use, but no validated instrument measures competencies specific to social media. This study aimed to adapt and validate the eHealth Literacy Scale (eHEALS) for this context. Methods: A content validation process was conducted with 33 experts, who evaluated the clarity, coherence, and relevance of the adapted questionnaire using item-level (I-CVI) and scale-level (S-CVI) content validity indices. A pilot study was then carried out with 250 participants to assess the instrument’s reliability and feasibility, measured through Cronbach’s alpha and McDonald’s Omega. Results: The adapted eHEALS demonstrated excellent content validity (S-CVI > 0.90) and high internal consistency (Cronbach’s α = 0.92; McDonald’s Ω = 0.92). The tool effectively captures key competencies for evaluating and applying health information in social media contexts, with exploratory factor analysis confirming a unidimensional structure that explained over 60% of the variance, supporting its robustness for use in population-based studies. Conclusions: This validated instrument provides a reliable method for assessing digital health literacy in social media, supporting the development of educational interventions to enhance critical appraisal skills and mitigate the impact of misinformation. Full article

Background: Globally, there is a growing demand for the adoption of electronic health systems and the transition toward digital processes within healthcare organizations. Electronic Medical Records (EMRs) play a vital role in enhancing documentation accuracy, improving healthcare delivery, and minimizing medical errors. However, limited research has explored nurses’ perceptions of EMR effectiveness within Ministry of Health hospitals in Jeddah City. Methods: A quantitative descriptive cross-sectional design was employed in four governmental hospitals affiliated with the Ministry of Health in Jeddah. A convenience sampling technique was used to recruit 911 full-time registered nurses from inpatient and outpatient departments. Data was collected through an electronic self-administered questionnaire evaluating EMR use, system quality, and user satisfaction. Descriptive and inferential statistical analyses were conducted using SPSS version 26. Results: The global EMR score (82%) reflected a high level of acceptance and integration of EMR systems among the nurses surveyed. The use of order entry received the highest mean score (84.8%), indicating that nurses find EMRs particularly effective in streamlining administrative and clinical tasks, such as medication orders and care plans. The strong correlation between system quality and user satisfaction (rs = 0.911) underscores the importance of well-designed EMRs in fostering trust and confidence among clinical users. Conclusions: The findings indicate that nurses perceive EMRs as effective tools for improving documentation, care coordination, and workflow efficiency. This study recommends the establishment of structured feedback mechanisms that enable nurses to report issues, suggest improvements, and share success stories—thereby fostering a culture of continuous system enhancement. Full article

Background/Objectives: Older adults with cancer are at high risk of developing delirium. Comprehensive geriatric assessment (CGA) is a fundamental tool for prioritizing problems and establishing appropriate interventions in older patients. This study aimed to identify risk factors for delirium through a CGA in older adults receiving palliative cancer care in hospital. Methods: This longitudinal observational study included people aged 65 years or over who were hospitalized in medical wards with an advanced stage of cancer. Clinicians performed a CGA and screened for delirium using the Confusion Assessment Method (CAM). Diagnosis of delirium was based on criteria set out in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V). We calculated odds ratios (ORs) with 95% confidence intervals (CIs) to compare different variables in people with versus without delirium. Results: The study included 105 participants, of whom 67 (63.81%) developed delirium during follow-up. The mean age was 71.33 years in the delirium group and 72.24 years in the non-delirium group. Risk factors for delirium were dysphagia (OR 2.45, 95% CI 1.01–5.99; p = 0.045), urinary catheterization (OR 2.97, 95% CI 1.09–8.13; p = 0.029), and having at least one delirium episode in the last year (OR 5.68, 95% CI 1.97–16.34; p = 0.001). The predictive model showed that older male cancer patients with a urinary catheter and dysphagia are most likely to develop delirium in hospital (area under the curve [AUC] = 0.679, 95% CI 0.577–0.780; p = 0.002). Conclusions: The prevention and effective management of delirium require a person-centered, interdisciplinary approach that considers both clinical and psychosocial aspects. Including variables such as male sex, dysphagia, and urinary catheterization in delirium risk assessment enables more comprehensive and personalized management. Full article

Background/Objectives: Informal caregivers play an important role in the palliative care of terminally ill family members at home. However, they often lack sufficient professional support, particularly in coping with emotional, spiritual, and practical challenges. This study aimed to explore caregivers’ experiences of providing care to a terminally ill family member at home. Methods: A qualitative approach was used to collect information from informal caregivers. Data were collected through interviews, and thematic analysis was used to identify the main challenges, coping mechanisms, and perceptions related to palliative care. Results: The study resulted in three themes: Involvement of professionals; The reality and dignity of death, and Life after death. Caregivers often associate palliative care exclusively with the last days of life, leading to delayed involvement of the mobile palliative care team. They stated that they preferred home care to hospital care and associated this with more positive experiences at the end of life. However, many reported feelings of loneliness and emotional distress, indicating a lack of appropriate psychological support. Spiritual care is often confused with religious practices, indicating a need for further education. Conclusions: The early involvement of mobile palliative care teams improves coping, facilitates a more humane dying process at home, and can reduce the emotional burden on caregivers. Full article

Screening for diabetes-specific distress should be considered a standard component of diabetes management. This study aimed to evaluate the psychometric properties of the Serbian adaptation of the Problem Areas in Diabetes—Teen Version (PAID-T). Methods: A multicentre, validation, cross-sectional study was conducted with 374 adolescents (aged 13–18 years) diagnosed with type 1 diabetes (T1D), all of whom completed the Serbian version of the PAID-T. The psychometric evaluation included assessments of construct validity through exploratory (EFA, first subsample, n = 140) and confirmatory (CFA, second subsample, n = 234) factor analyses, as well as examinations of concurrent and convergent validity. Reliability was evaluated using measures of internal consistency and test–retest stability (n = 289). Results: Factor analyses indicated some multidimensionality; however, the high correlations between factors in the three-factor model and the optimal fit of the hierarchical three-factor model with a single second-order factor supported the interpretation that the PAID-T measures a unified construct, with satisfactory fit indices (CFI = 0.95; TLI = 0.93; RMSEA = 0.08; SRMR = 0.05). Concurrent validity testing demonstrated gender-based differences in adolescents’ perceptions of the emotional burden of diabetes (W = 19.718, p = 0.03, small effect size = 0.11). Convergent validity analyses showed that adolescents who were non-adherent to treatment (W = 11.390, p = 0.01, small effect size = 0.13) or experienced difficulties managing diabetes at school (W = 16.333, p < 0.001, small effect size = 0.16) reported significantly higher levels of diabetes-specific distress. A significant negative correlation was also observed between PAID-T scores and perceived social support (ρ = −0.24, p < 0.001). Importantly, Serbian adolescents with T1D reported mean PAID-T scores close to the cutoff point of 44, indicating clinically relevant levels of distress. The Serbian version demonstrated strong internal consistency (Cronbach’s α = 0.92; McDonald’s ω = 0.93) and excellent test–retest reliability (ICC = 0.99, 95% CI), confirming stability over time. Conclusions: The Serbian adaptation of the PAID-T demonstrated strong validity and reliability, supporting its use as a robust tool for assessing self-reported diabetes-specific distress in adolescents. Notably, the mean PAID-T scores in Serbian adolescents with T1D were close to the established cutoff point of 44, underscoring the clinical relevance of routine screening in this population. The early identification of diabetes distress can enable nurses and other members of the multidisciplinary healthcare team to deliver tailored interventions, ultimately improving psychological well-being and health outcomes. Full article

Background: Stroke survivors and their family caregivers face substantial burdens resulting from a complex interplay of clinical, functional, and psychosocial factors. Community-based resources and social networking are critical for alleviating caregiver burden and improving outcomes for both caregivers and stroke survivors. Objectives: To assess the Saudi population’s readiness to use social platforms for stroke survivors’ recovery and caregiver support. Methods: A cross-sectional descriptive design was employed between March and June 2025 to collect data from community-dwelling individuals using sociodemographic and Technology Readiness Index (TRI) questionnaires. Results: A convenience sample of 576 participants was enrolled in this study. Overall, the participants showed a high level of technology readiness, with a total TRI mean score of M = 3.65, SD = 0.86. Optimism had the highest mean score, followed by innovativeness, insecurity, and discomfort. Significant differences in technology readiness were identified based on age, educational level, employment status, familiarity with modern technology, and healthcare provider status. Conclusions: This study demonstrates a high level of technological readiness across the Saudi population, indicating strong potential for integrating social connection platforms into stroke recovery and caregiver support. These findings align with Saudi Arabia’s Vision 2030 goals for digital transformation in the healthcare sector. Future research should focus on conducting feasibility studies to better understand the desirable features of e-health services and digital solutions within the Saudi community. Full article

Background: The Nursing Work Environment (NWE) plays a critical role in determining the quality of care, staff well-being, and organizational performance, particularly in oncology settings. Despite increasing attention, a comprehensive synthesis of organizational factors shaping oncology NWEs has been lacking. This scoping review aimed to describe the key features of oncology NWEs and to explore the outcomes associated with these characteristics. Methods: A scoping review was conducted following the Joanna Briggs Institute guidelines. Peer-reviewed studies published in English or Italian were included without time restrictions. Literature searches were performed in MEDLINE via PubMed, CINAHL, and Scopus between January and April 2025. Results: Twenty studies met the inclusion criteria. Key organizational characteristics of oncology NWEs were grouped into the following four domains: leadership and organizational support; workload and resource availability; ethical climate and collegial relationships; and physical and structural conditions of care settings. Across the studies, a positive NWE was frequently reported to be associated with improved nurse-related outcomes and, to a lesser extent, with patient-related outcomes. However, these associations should be interpreted with caution due to the heterogeneity of contexts and the predominance of cross-sectional designs. Conclusions: The NWE is a strategic element in delivering effective, safe, and sustainable oncology care. Practical actions for nurse managers and healthcare leaders include implementing leadership training programs, ensuring adequate staffing and resource allocation, fostering open communication, and promoting interdisciplinary collaboration. These measures are essential to protect staff well-being and guarantee high-quality, patient-centered care. Full article

Background/objectives: Falls are the most common adverse events in hospitals. This study aimed to estimate excess hospitalisation costs attributable to inpatient falls, using Diagnosis-Related Group (DRG) relative weights as a proxy for resource consumption. Methods: Case–control study. Cases included patients who had sustained a fall during hospitalisation between 2020 and 2022 in 19 inpatient units. Controls were selected with matching technique based on age and admission period. Diagnosis-Related Groups and their resource consumption and cost estimators (relative weights) were provided by the Hospital’s Coding Unit. Results: A total of 613 falls were analysed against 623 controls. The Diagnosis-Related Group ‘Lower limb amputation except toes’ was associated with a fourfold higher risk of falling compared to others. Five more were identified in which the case group incurred significantly higher costs than the control group. These included three surgical Diagnosis-Related Group, ‘Urethral and transurethral procedures’, ‘Heart valve procedures without acute myocardial infarction or complex diagnosis’, and ‘Arterial procedures on the lower limb’, and two medical, ‘Heart failure’ and ‘Major pulmonary infections and inflammations’. Conclusions/Implications for practice: Identifying Diagnosis-Related Groups in which falls are associated with increased hospitalisation costs allows for a comprehensive assessment of the process, taking into account resource consumption and the clinical characteristics of hospitalised patients. These findings will enable nurses to develop targeted strategies to enhance the safety of hospitalised patients that contribute to the sustainability of the healthcare system. Full article

Background/Objectives: Effective clinical handover is a critical component of nursing care, particularly in mental health settings, where the transfer of clinical and behavioral information is essential for both patients’ and health personnel’s safety. Gamification has emerged as a promising strategy to enhance clinical education, yet few interventions have focused specifically on mental health care contexts. This study aimed to evaluate the effectiveness of a serious game designed to teach the SBAR (Situation, Background, Assessment, Recommendation) handover framework to undergraduate nursing students through a psychiatric care unit scenario. Methods: A quasi-experimental pre–post design was employed with a convenience sample of 48 nursing students from a Northern Italian university. Participants completed a test assessing their ability to organize clinical information according to the SBAR model before and after the game intervention. Students’ experience was assessed using the Player Experience Inventory. Results: A statistically significant improvement in SBAR application was observed post-intervention. The majority of students reported a positive experience across PXI domains such as Meaning, Challenge, Progress Feedback, and Enjoyment. Comparisons with a previously validated video-based nursing serious game showed a consistent overall pattern in response trends. Conclusions: The SG was an effective and engaging educational tool for improving structured handover skills in nursing students. Gamification may represent a valuable complement to traditional instruction in nursing education, especially in high-communication clinical areas such as mental health. Further research is needed to assess long-term retention and to explore more immersive formats. Full article

Background: Rare diseases affect fewer than 1 in 2000 people, but collectively, they impact millions. Their diagnosis and management present challenges due to low prevalence, clinical heterogeneity, and a lack of standardized protocols. Nurses play a key role in assisting and caring for these patients by providing direct care, emotional support, and health education. Objective: The objective of this systematic review is to update the existing knowledge on nurses’ level of understanding regarding rare diseases, as a decline in their training can compromise the quality of care and access to early detection. Methodology: A bibliographic search was conducted in Scopus, PubMed, CINAHL, SciELO, and Cochrane Library, selecting studies published between 2014 and 2024 on rare disease knowledge. The PRISMA model was followed, and the review was registered with PROSPERO under code CRD42024580656. Result: Ultimately, 24 studies were included. The main results showed a significant gap in nursing education concerning rare diseases. Conclusions: Continuous education, telemedicine, and the integration of health technologies were highlighted as improving competencies in rare diseases. Therefore, it is a priority to increase nursing training in rare diseases at all levels. Full article

Background: Sense of coherence constitutes a significant personal resource that underpins the harmonious professional functioning of nurses employed in psychiatric inpatient wards. It serves as a protective factor, enabling effective coping with the psychophysical burden arising from a demanding and stress-inducing work environment, while also supporting the maintenance of a high level of job satisfaction. Regular assessment of the sense of coherence among psychiatric nursing staff is essential for the early identification of individuals at risk of developing occupational burnout. The aim of the present study was to determine the relationship between the level of sense of coherence and the degree of occupational burnout among nurses working in inpatient psychiatric units. Methods: The study employed a cross-sectional design and utilized standardized psychometric instruments, including The Sense of Coherence Questionnaire (SOC-29) to assess the level of coherence, and the Maslach Burnout Inventory (MBI) to measure occupational burnout. Additionally, a self-developed questionnaire was used to collect sociodemographic data. The research was conducted in five psychiatric hospitals in Poland between January and June 2023. The sample consisted of 555 nurses (449 women and 106 men) employed in inpatient psychiatric wards. Statistical analyses included descriptive statistics, Pearson’s correlation coefficients to examine relationships between variables, and multiple linear regression to identify predictors of burnout dimensions. Significance level set at p < 0.05. Results: The mean global sense of coherence score among psychiatric nurses was 124.68 (SD = 45.81), with manageability scoring highest among subscales (43.83, SD = 16.28). Average occupational burnout scores were emotional exhaustion 28.75 (SD = 16.39), depersonalization 13.55 (SD = 9.71), and reduced personal accomplishment 23.61 (SD = 11.11). Significant negative correlations were found between sense of coherence (and its components) and all burnout dimensions (p < 0.001). Manageability was the strongest predictor of lower emotional exhaustion (β = −0.73), depersonalization (β = −0.65), and reduced personal accomplishment (β = −0.65), while meaningfulness predicted depersonalization (β = 0.37, p = 0.012). These results indicate that higher sense of coherence, especially manageability, is linked to reduced burnout among psychiatric nurses. Conclusions: The study revealed significant negative associations between sense of coherence and all dimensions of occupational burnout, with manageability emerging as the strongest protective factor. Nurses with higher levels of sense of coherence reported lower emotional exhaustion, depersonalization, and reduced personal accomplishment. These findings highlight the importance of incorporating sense of coherence assessment into strategies for identifying individuals at increased risk of burnout. Full article

Background/objectives: Dementia is the most common cause for long-term care placement for people over the age of 65 years. The decision and the transition are often very difficult for families and the type and timing of effective support not well understood. In this exploratory study, we aimed to gain a better understanding of the experience of this transition to a long-term care setting and its impact on social connections. Methods: We conducted virtual in-depth interviews with a sample of spouses (N = 5) who had identified their partner’s move to a nursing home as particularly distressing. Interview data were analyzed using thematic analysis. Results: We identified that the transition process involved a particular disruption for dyads’ social health, although there was rarely a consideration in planning or support provision. For the person living with dementia, the unacknowledged loss of their social world reinforced their social death. Their grieving partner was explicitly and implicitly encouraged to recover a new social world as a means of healing from the loss. Conclusions: Our findings reinforce the need for evidence-informed support during the transition to long-term care for someone living with dementia and their partner. Full article

Introduction: Eliminating mother-to-child transmission (EMTCT) of HIV is a global health priority to ensure that no child is born with HIV. When EMTCT services are underutilized, mothers and babies face greater risks, including the vertical transmission of HIV and higher rates of maternal and neonatal mortality. Despite ongoing efforts, many women worldwide still struggle to access and use these vital services. Objective: This study sought to explore barriers and facilitators to the elimination of mother-to-child transmission services among pregnant and breastfeeding women (PBFW) in Gauteng province, South Africa. Methods: A qualitative, explorative, and descriptive research design was used. Convenience and purposive sampling were used to select participants. The study population consisted of PBFW aged 18 years or above who were utilizing EMTCT services. Data was collected through in-depth face-to-face individual interviews with participants. A semi-structured interview guide was used to collect data until data saturation was reached after interviewing 25 participants. Data were analyzed using thematic analysis (Tesch’s open coding method). Trustworthiness and ethical principles were ensured. Results: Four main themes emerged from the data analyzed, namely, barriers associated with EMTCT service utilization, facility-based strategies to improve EMTCT service uptake, community support for enhancing EMTCT engagement, and the role of partner support in service utilization, each with linked sub-themes. This study found that health education about EMTCT, along with community awareness and involvement, encourages the target group to utilize these services. Conclusions: Increasing women’s use of EMTCT services is an important step toward eliminating MTCT and increasing the health and well-being of mothers and their children. Addressing numerous barriers to receiving these services, as well as implementing targeted measures, can help ensure that all women gain access to the care and support that they require to safeguard their families from HIV. Full article

Background/Objectives: The transition from theoretical knowledge to clinical practice poses significant challenges for nursing students globally. This critical period requires comprehensive educational support to build confidence and competence. While short-term preparatory courses have shown promise internationally, their effectiveness within the Saudi Arabian context remains understudied. This study aimed to evaluate nursing students’ satisfaction and self-confidence following participation in short-term preparatory courses conducted before clinical placements at Taibah University, Saudi Arabia. Methods: A descriptive cross-sectional study was conducted from February to April 2025. Data were collected from 117 undergraduate nursing students (response rate: 80.7%) using a validated questionnaire adapted from the National League for Nursing’s Student Satisfaction and Self-Confidence in Learning instrument. The preparatory courses included nursing care plan development, hospital orientation, and infection control procedures delivered over two weeks. Statistical analysis included descriptive statistics and Pearson correlation analysis. Results: Students reported high levels of satisfaction (mean = 4.29 ± 0.92) and self-confidence (mean = 4.31 ± 0.81) scores. The highest satisfaction was with instructor effectiveness (mean = 4.31 ± 1.05) and teaching methods (mean = 4.32 ± 1.01). Students demonstrated strong confidence in personal learning responsibility (mean = 4.44 ± 0.88) and skill development (mean = 4.32 ± 0.95). A strong positive correlation existed between satisfaction and self-confidence (r = 0.79, p < 0.001). Conclusions: Short-term preparatory courses effectively enhanced nursing students’ satisfaction and self-confidence in the Saudi Arabian context. The strong correlation between these constructions suggests that educational interventions improving one dimension is likely to benefit the other. These findings support integrating structured preparatory programs into nursing curricula to facilitate successful clinical transitions. Full article

Background: Empathy is essential for enhancing care quality, making its understanding and predictors crucial for healthcare education. Objective: To investigate empathy evolution and its predictors among first-year health professional students at a university in Albania. Methods: A longitudinal cohort study was conducted on a total of 206 participants (78.2% female, mean age 18.4 years), with empathy assessed at baseline and program completion using the Jefferson Scale of Empathy-Health Professional Students. Results: The findings revealed stable empathy levels overall (p = 0.369), with no significant differences between nursing and other students. Approximately 52.9% experienced empathy gains, while 44.7% experienced losses, yielding an average score change of +0.7 (SD = 14.9). A younger age and lower baseline empathy scores were significant predictors of empathy gains, as shown by regression analyses. Conclusions: The study highlights a dual empathy trajectory among students and emphasizes a person-centered approach to health professional education to foster empathy development. Full article

Background: China’s rapidly ageing population faces a double burden of social frailty (SF) and social isolation (SI), both of which accelerate functional decline and increase healthcare use. Clarifying their interplay is essential for nurses, who are often the first to assess and intervene in older adults’ social health. Method: In a cross-sectional study, 451 community-dwelling adults aged ≥ 60 years (median = 71) completed the HALFT Social Frailty Scale and the Social Isolation Scale for Older Adults. A mixed graphical model based on Spearman correlations mapped symptom-level associations between SF and SI and identified central nodes. Result: SF was present in 22.8% of participants, and the median SI score was 13 (IQR = 9–16). The strongest edge linked “inability to help others” (SF1) with reduced “face-to-face contact frequency” (SI1) (edge weight = 1.85). Central nodes were “lack of social participation” (SI2), “sense of belonging” (SI4), and “lack of someone to talk to” (SF5), indicating key points where SF and SI converge. Conclusions: The tight network connecting SF and SI suggests that nursing assessments should screen for both constructs simultaneously. Interventions that increase social participation, foster belonging, and create opportunities for reciprocal helping may mitigate both syndromes, supporting healthier ageing and reducing downstream healthcare utilization. Full article

Background: Adherence of renal patients to a prescribed therapeutic regimen is crucial for the success of haemodialysis and the decreased mortality rates of patients; however, 60% are non-adherent to dialysis, fluid, and dietary allowances. To identify promising interventions aimed at improving treatment adherence, this review aimed to collate research evidence on the prevalence of non-adherence to treatment (fluid, diet, and routine haemodialysis) and to synthesise the factors contributing to non-adherence in long-term haemodialysis patients. Methods: An integrative review was conducted using Whittemore and Knafl’s five-stage framework (2005). ProQuest, CINAHL, PubMed, and Web of Science were searched, using the keywords ‘haemodialysis’ and ‘non-adherence’. The review included peer-reviewed quantitative studies published in English from 1 August 2018 to 30 June 2025, focusing on adults over 18 undergoing haemodialysis. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist was used to assess the quality of the studies. Results: Twenty-nine studies were included, identifying factors across four treatment groups: non-adherence to fluid allowance, dietary allowance, haemodialysis session, and fluid/diet/haemodialysis. These factors were grouped into three themes: social demographics, clinical factors, self-management, and perceptions. Commonly cited factors included age, gender, educational status, health literacy, and perception. Conclusions: This review highlights the complex factors influencing treatment non-adherence, which may vary based on the variables and measurement tools used in each study. Low-level health literacy is the most frequently cited modifiable factor. Therefore, prioritising effective patient education that enhances knowledge and understanding of the importance of adhering to treatment is key to improving compliance in long-term haemodialysis patients. Full article

Background/Objectives: In today’s rapidly evolving healthcare landscape, fostering a culture of innovation and continuous improvement is essential—especially within a nursing association that leads individual and organizational credentialing. Methods: Colleagues from the American Nurses Enterprise (ANE) Innovation Department and the Institute for Nursing Research and Quality Management collaborated to develop the Culture of Innovation and Quality Model^TM. This process involved conducting a literature review, developing a survey instrument, and administering a pilot pre-survey to ANE employees to collect baseline data. Future research will include a comparison with a post-survey after interventions aimed at strengthening the culture of innovation and quality. Results: The results of the pilot pre-survey were high overall and guided the team in identifying areas with the greatest opportunities for improvement. Based on these findings, interventions are being developed that will be implemented at ANE to enhance the practice of and promote the synergy between innovation and quality. Conclusions: Achieving and sustaining high-quality standards of care and advancing the professional development of nurses requires a culture where staff feel safe and have opportunities to create, innovate, improve, and learn. This will help promote an environment where people thrive while ensuring that the nursing profession and practice remain cutting-edge and aligned with emerging technologies and evolving healthcare complexities. The Culture of Innovation and Quality Model^TM may provide a blueprint for organizations who seek to advance innovation and quality knowledge, engagement, and practices and assist their employees in providing better service to colleagues, partners, and customers while adapting to the evolving healthcare environment. Full article

Background: Undergraduate nursing students (UNSs) often enter clinical training just as they are still mastering the emotional labor of the profession. In Nepal, where teaching hierarchies discourage upward dialogue and hospitals routinely struggle with overcrowding, supply shortages, and outward nurse migration, these learners confront a distinct, under-documented burden of psychological distress. Objective: This study examines how UNSs interpret, negotiate, and cope with the mental health challenges that arise at the intersection of cultural deference, resource scarcity, and migration-fueled uncertainty. Methods: A qualitative design employing reflexive thematic analysis (RTA), guided by the Reflexive Thematic Analysis Reporting Guidelines (RTARG), was used. Fifteen second-, third-, and fourth-year Bachelor of Science in Nursing students at a major urban tertiary institution in Nepal were purposively recruited via on-campus digital flyers and brief in-class announcements that directed students (by QR code) to a secure sign-up form. Participants then completed semi-structured interviews; audio files were transcribed verbatim and iteratively analyzed through an inductive, reflexive coding process to ensure methodological rigor. Results: Four themes portray a continuum from silenced struggle to systemic constraint. First, Shrouded Voices, Quiet Connections captures how students confide only in trusted peers, fearing that formal disclosure could be perceived as weakness or incompetence. Second, Performing Resilience: Masking Authentic Struggles describes the institutional narratives of “strong nurses” that drive students to suppress anxiety, adopting scripted positivity to satisfy assessment expectations. Third, Power, Hierarchy, and the Weight of Tradition reveals that strict authority gradients inhibit questions in classrooms and clinical placements, leaving stress unvoiced and unaddressed. Finally, Overshadowed by Systemic Realities shows how chronic understaffing, equipment shortages, and patient poverty compel students to prioritize patients’ hardships, normalizing self-neglect. Conclusions: Psychological distress among Nepalese UNSs is not an individual failing but a product of structural silence and resource poverty. Educators and policymakers must move beyond resilience-only rhetoric toward concrete reforms that dismantle punitive hierarchies, create confidential support avenues, and embed collaborative pedagogy. Institutional accountability—through regulated workloads, faculty-endorsed wellbeing forums, and systematic mentoring—can shift mental health care from a private struggle to a shared professional responsibility. Multi-site studies across low- and middle-income countries are now essential for testing such system-level interventions and building a globally resilient, compassionate nursing workforce. Full article

Background/Objectives: We identified the factors related to post-intensive care syndrome in a sample of patients from northern Colombia. Methods: This study employed a quantitative, observational, descriptive, and correlational approach. A sample of 277 adults was obtained through non-probabilistic convenience sampling, and a characterization form comprising sociodemographic and clinical variables was applied. The Healthy Aging Brain Care Monitor (HABC-M) instrument was also used, which is a clinical tool with a high capacity to detect post-intensive care syndrome (PICS) in surviving intensive care unit (ICU) patients. Results: The final sample consisted of 277 adults, 67.5% male, with university degrees, cohabiting in a marital union, working, from urban areas, and of the Catholic religion. Seventy percent of the sample presented both cardiovascular and neurological alterations and was admitted to the ICU, and 66% had a personal history of arterial hypertension (AHT) and type 2 diabetes mellitus (DM2). Patients had a mean ICU stay of 10.7 days, with a standard deviation of 4 days, and displayed a moderate risk of morbidity and mortality according to Acute Physiology and Chronic Health Evaluation II (APACHE II). A total of 38.6% of the sample received mechanical ventilation, with a mean duration of 8.3 days, and 7.5% underwent tracheostomy. As for sedation, 38.6% were administered fentanyl. In total, 83.4% of the sample presented the syndromes under study, with a predominance of the severe category. The global score of the scale was taken as the dependent variable, and statistical significance (p < 0.05) was found with sociodemographic variables, including origin and religion, and with clinical variables such as receiving pharmacological treatment. Conclusions: The sample presented PICS globally and showed how it affects the different dimensions, showing associations with the sociodemographic and clinical variables of interest. Full article

Aim: We aimed to assess the impact of a Health and Nursing course on the professional commitment of first-year undergraduate nursing students and obtain quantitative and qualitative feedback on teaching. Design: This study employed a quasi-experimental design. Methods: Fifty first-year undergraduate nursing students who attended the Health and Nursing course were recruited. A self-designed basic information questionnaire, the Nursing Professional Commitment Scale, the Students’ Perceived Teaching Quality Questionnaire, and two quick open-ended questions were used to collect the data. Professional commitment before and after the intervention was compared using an independent samples t-test. The correlation between the students’ perceived teaching quality and professional commitment was assessed using Pearson’s correlation coefficient. Content analysis was used to analyze qualitative feedback. Results: The participants experienced a significant improvement in their professional commitment. The students’ perceived teaching quality was significantly correlated with their professional commitment. According to the students’ feedback, the most impressive aspects of the course were case-based learning and visits to healthcare institutions. Conclusions: A Health and Nursing course with high-quality teaching increased the professional commitment of first-year undergraduate nursing students. The findings suggest that nursing educators should consider the external macro-sociopolitical environment when designing an introductory course to equip students with a broader perspective on nursing professional development. Teaching content and pedagogy should be improved to promote knowledge delivery and internalization. Full article

Background/Objectives: The emergence of artificial intelligence (AI) has revolutionized the healthcare industry. However, its integration into clinical practices raises ethical and practical concerns. This study aims to explore ethical and practical considerations perceived by physicians and nurses in Saudi Arabia. Methods: It employed a cross-sectional design with 400 physicians and nurses, using a pre-established online questionnaire. Descriptive data were analyzed through means and standard deviations, while inferential statistics were performed using the independent samples t-test. Results: Most participants were male (57%) and physicians (73.8%), with most employed in governmental organizations (87%). The participants’ use and awareness of AI was low, as 34.0% said they had never used it, but 74.5% of respondents were willing to use AI in clinical practices. Also, 80.5% of participants were aware of the AI benefits, and 71.0% had background knowledge about the ethical concerns related to AI’s implementation in their clinical practices. Moreover, (62.0%) of respondents recognized the applicability of AI in their specialty. Key findings revealed significant concerns: participants perceived a lack of skills to effectively utilize AI in clinical practice (mean = 4.04) and security risks such as AI manipulation or hacking (mean = 3.83). The most pressing ethical challenges included AI’s potential incompatibility with all populations and cultural norms (mean = 3.90) and uncertainty regarding responsibility for AI-related errors (mean = 3.84). Conclusions: These findings highlight substantial barriers that hinder the effective integration of AI in clinical practices in Saudi Arabia. Addressing these challenges requires leadership support, specific training initiatives, and developing practical strategies tailored to the local context. Future research should include other healthcare professionals and qualitatively explore further underlying factors influencing AI adoption. Full article