Nurs. Rep., Volume 16, Issue 1 (January 2026) – 36 articles

Background/Objectives: Nurses are at high risk for burnout. Identification of biomarkers associated with early manifestations of distress is essential to support effective intervention efforts. Methods: Fifty nurses from a large hospital system participated in a 30-day study of biopsychosocial factors that may contribute to burnout. Nurses wore an Oura ring that collected behavioral data and they completed a self-report burnout questionnaire at baseline and the end of the study period. Machine learning models were developed to evaluate whether objective measures could predict burnout states and changes at the end of the study period. Analyses were exploratory and hypothesis-generating for future work. Results: Data for 45 participants were included in the analyses. Participants with burnout had significantly higher sleep variability. Sleep measures provided 75.75% accuracy in ability to discriminate between burnout states. Heart rate-based measures better modeled changes in symptomatic components of burnout (Emotional Exhaustion, Depersonalization) over time. Heart rate-based measures provided a R-squared value of 0.13 (p < 0.05) (RMSE of 7.41) in a regression model of changes in Emotional Exhaustion evaluated in a leave-one-participant-out cross-validation. Conclusions: Sleep measures’ association with a state of burnout may reflect the longer-term manifestations of chronic exposure to workplace stress. Short-term changes in burnout symptoms are associated with disturbances in heart rate measures. Wearable technology may support monitoring/early identification of those at risk for burnout. Full article

Background: Patients are the most frequent perpetrators of physical violence against nurses. In the United States, most states have established laws designating assault against nurses a felony, or serious crime. It is unknown what reasons nurses have for pressing charges or not pressing charges against patients. Purpose: The purpose of this study was to examine nurses’ decisions regarding pressing charges when patients exhibit violent behavior. Methods: This study used a mixed-method, cross-sectional, descriptive design. Three unfolding case studies were presented in an electronic survey. Twelve versions of the survey were randomly assigned to participants. Each described an adolescent, adult, and geriatric patient. The narrative descriptions were identical, but the visual representations of the patients differed. Results: A total of 499 nurses from seven hospitals in the western United States responded. Most nurses indicated that they would not press charges against any of the hypothetical patients. An injury occurring and an assumption of intentionality contributed to nurses’ decisions to press charges. Participants were more likely to press charges against the adolescent and adult patients than the geriatric patient. The hypothetical adolescent and geriatric patients were more likely to have charges pressed against them if presented as female than if presented as male. The hypothetical adult patient was more likely to have charges pressed against them if presented as white than if presented as black. Conclusions: There is no consensus regarding when a nurse ought to pursue legal action against a patient who exhibits violent behavior. In addition to the presence of injury and the assumption of intentionality, it is possible that implicit bias may also play a role in these decisions. More investigation into this is needed. Full article

Background/Objectives: Self-care is central to chronic illness management and is particularly relevant in osteoporosis to prevent complications and improve quality of life. Grounded in Riegel’s middle-range theory of self-care of chronic illness, the study sought to understand the contextual, emotional, and structural influences shaping self-care in people living with osteoporosis. Aim: The aim of this study was to explore patient-reported barriers and facilitators to self-care behaviors among individuals living with osteoporosis. Methods: A qualitative descriptive design was conducted using in-depth, semi-structured interviews with 20 patients with osteoporosis recruited via convenience sampling. Data were coded deductively and analyzed using Mayring’s qualitative content analysis with a deductive approach. Results: Participants identified several factors related to both barriers and facilitators of self-care behaviors. Four barrier sub-themes emerged: ineffective coping strategies, difficulties in osteoporosis management, inadequate physical activity, and ineffective self-efficacy. Six facilitator sub-themes were identified: self-care management strategies, osteoporosis management after a fracture, osteoporosis control, osteoporosis treatment, exercise, and confidence in one’s ability. Main barriers included fear of falling, ineffective self-efficacy, and poor care continuity, whereas key facilitators included support networks, motivation, and tailored care. Conclusions: Self-care behaviors in individuals with osteoporosis are influenced by emotional, contextual, and structural factors. Person-centered interventions integrating emotional and educational components may strengthen patients’ engagement and enhance self-care behaviors in osteoporosis. Identifying barriers and facilitators enables nurses to design empathetic, tailored strategies that enhance empowerment and disease management. Understanding these factors can improve autonomy for patients and adherence, promoting long-term health outcomes across clinical and community settings. Full article

Background: Narrative Medicine (NM) has emerged as a strategy to support reflective clinical practice and emotional resilience among nurses. This study examined relationships between NM practices and well-being among registered nurses (RNs) and nurse practitioners (NPs). Methods: A national sample of RNs and NPs was recruited using snowball sampling. Participants completed a NM practice survey and the Mayo Clinic Well-Being Index (WBI) survey. Data were analyzed using descriptive statistics and Pearson correlation coefficients. Results: A total of 3167 responses were analyzed (1934 RNs and 1233 NPs). Among RNs, strong statistically significant correlations were found between NM practices and well-being scores (p < 0.001). Among NPs, moderate correlations appeared in select NM practice dimensions (p < 0.05). Conclusions: Engagement in narrative Medicine practices is associated with improved well-being among nurses and nurse practitioners. NM may present a promising strategy to reduce burnout and strengthen professional resilience. Full article

Background/Objectives: Given the critical role of vaccinations and venipunctures in disease prevention and health monitoring, it is concerning that over half of children ages 4 to 8 experience some level of needle fear. Higher levels of fear result in longer procedure times, ineffective pain management, distressing memories of needles, and ultimately, healthcare avoidance. Exposure-based therapy with a therapist is recommended for high levels of fear. However, access is limited due to cost, wait times, clinician shortages, system barriers, and social stigma. Thus, there is a need for an evidence-informed, caregiver-directed educational resource for management of moderate to high needle fear in young children. Methods: To address this gap, such a resource was drafted which included a caregiver guide and an illustrated children’s book. The current objective was to gather key user feedback on this initial version of the resource. Participants reported their perceptions of the content, coping strategies, design, organization, and accessibility of the resource through semi-structured interviews and limited quantitative ratings. Participants were children with moderate to high levels of needle fear (N = 6), their caregivers (N = 6), and healthcare professionals (N = 6; including needle providers, child life specialists, and mental health clinicians). Interviews were coded with inductive content analysis; descriptive statistics were calculated for quantitative ratings. Results: Participants reported satisfaction with the e-resource and highlighted strengths (e.g., CARD^TM system, children’s book) and improvement areas (e.g., length, language). Conclusion: Feedback informed revisions to the e-resource in preparation for further evaluation in a follow-up study. Full article

Background/Objectives: Heel pressure ulcers are a relevant complication in critically ill patients and may negatively affect recovery after ICU discharge. This study investigated health-related quality of life (HRQoL) and mobility levels one year after ICU discharge in survivors who developed heel pressure ulcers. Methods: A prospective observational study was conducted in the ICU of an academic tertiary-level hospital in Milan (Italy) from 1 January 2023 to 31 December 2024. Adult survivors were enrolled, and HRQoL was assessed using the EQ-5D-5L questionnaire. Functional status at ICU discharge was evaluated using the Manchester Mobility Score and Barthel Index. This study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Results: Among 3144 ICU admissions, 52 survivors were enrolled. At ICU discharge, functional status was markedly impaired: only 15 patients (28.9%) were able to stand upright according to the Manchester Mobility Score, and none achieved even moderate levels of independence. At one year, 47 patients (90.4%) completed the follow-up, and 15 of them (31.9%) continued to report moderate-to-severe mobility limitations. The mean EQ-5D index value was 0.75 (SD 0.27), representing a significant reduction compared with Italian population norms (p < 0.001). Conclusions: ICU survivors who developed heel pressure ulcers exhibit reduced HRQoL at one year after discharge. These findings emphasize the need for structured post-ICU rehabilitation and targeted follow-up. Full article

Background: Palliative care addresses not only physical symptoms but also the social, psychological, and spiritual needs of patients. Nurses play a key role in identifying and responding to these needs, yet their perceptions and preparedness may vary. Objectives: This study aimed to explore nurses’ perspectives on the psychological, social, and spiritual needs of palliative patients, assess how well these needs are being met, and examine the influence of nurses’ self-assessed education levels on their evaluations. Methods: A cross-sectional survey was conducted among 237 registered nurses with palliative care experience in Split-Dalmatia County, Croatia. Two validated questionnaires were used to assess the perceived importance of 53 patient needs and the extent to which these needs were satisfied. Results: Findings revealed significant discrepancies between the perceived importance and satisfaction of nearly all psychological, social, and spiritual needs (p < 0.001), particularly regarding fear of death, suffering, and future uncertainty. Only 38.4% of nurses considered themselves adequately trained in palliative care, though most had some educational exposure to it. No statistical differences were found in need assessment based on nurses’ self-rated education. Most nurses reported emotional exhaustion (72.6%) and supported interdisciplinary care (95.8%), while 90.3% noted that responsibility for care often falls on families. Conclusions: Nurses recognize critical unmet needs in palliative patients and feel insufficiently prepared to address them. These findings underscore the need to improve palliative care education, provide emotional support for nurses, and implement systemic healthcare reforms to ensure comprehensive, dignified care. Full article

Background/Objectives: Our previous study showed that the dietary structure is imbalanced in a majority of colorectal cancer patients receiving chemotherapy. These patients had higher risk of developing malnutrition. In the present study, we aimed to identify factors associated with nutritional risk in this cohort of patients. Methods: We performed a secondary analysis of a dataset that was originally collected to identify the factors that are associated with an imbalanced dietary structure in patients receiving chemotherapy for colorectal cancer. Nutritional risk was evaluated by using an NRS-2002 form. Binary logistic regression was used for multivariate analysis. Results: Among the 178 CRC patients enrolled in this study, 60 (33.7%) had nutritional risk. Patients with nutritional risk exhibited lower intake of grains, potatoes, vegetables, fruits, beans, nuts, and oils compared to those without risk. Multivariate analysis showed that non-surgery (95% CI: 0.130–0.914, p = 0.032) and high dietary structure score (95% CI: 0.808–0.944, p = 0.001) are associated with lower nutritional risk in CRC patients receiving chemotherapy. Conclusions: CRC patients receiving chemotherapy have moderate risk of developing malnutrition. Dietary structure score and surgery are associated with malnutrition in CRC patients receiving chemotherapy. Education on proper dietary structure is a potential strategy to mitigate nutritional risk in CRC patients undergoing chemotherapy. These findings highlight the need for personalized nutritional support to optimize patient outcomes. Full article

Background: Teamwork and effective communication are widely recognized as essential pillars for the safety and quality of healthcare. However, in Portugal, no validated instrument had previously been available to assess healthcare professionals’ attitudes toward teamwork. This study aimed to translate, culturally adapt, and validate the TeamSTEPPS^® Teamwork Attitudes Questionnaire (T-TAQ) for the Portuguese context, resulting in the Portuguese version of the instrument. Methods: A methodological study with a quantitative approach was developed. The translation and cultural adaptation process followed internationally recognized guidelines. The sample consisted of 162 healthcare professionals (136 nurses and 26 physicians) from a hospital in Lisbon. Exploratory and confirmatory factor analysis techniques were used to assess construct validity. The internal consistency of the scale was analyzed using Cronbach’s alpha coefficient. Results: The Portuguese version comprises 30 items distributed across five dimensions: Effective Leadership Support, Team Functional Performance, Teamwork Coordination, Willingness to Engage in Teamwork, and Team Functioning Supervision. The scale demonstrated a total explained variance of 53.9% and an overall internal consistency coefficient (α) of 0.86, indicating good reliability. Confirmatory factor analysis supported the five-factor structure of the scale (χ²/df = 1.461; CFI = 0.900; GFI = 0.821; RMSEA = 0.054; MECVI = 4.731). Conclusions: The T-TAQ-PT proved to be a valid, reliable, and robust instrument for assessing healthcare professionals’ individual attitudes toward teamwork, contributing to the development of research and clinical practice in the Portuguese context. Full article

Background/Objectives: Japan introduced a certification system for Advanced Practice Nursing Workforce (APNW) in 1996. The Japanese Nursing Association formally certified two types of the APNW: Certified Nurses (CNs) and Certified Nurse Specialists (CNSs). Little is known about the geographic distribution of CNs and CNSs. Methods: We conducted an ecological panel analysis using prefecture-level data from 1996 to 2022. To assess the degree of inequality of CN and CNS among prefectures, we calculated the Gini overall coefficients, as well as those by categories of CN and CNS, number of hospitals, number of hospital doctors, and hospital nurses. Using data available from 2000 to 2017, we examined factors associated with CN and CNS density through fixed-effects panel data analyses of log-transformed overall and category-specific densities. Results: During the study period, the number of CNs and CNSs consistently increased, and geographic disparities in their distribution decreased until around 2010. After 2010, however, geographic disparities in prefectures with persistently low CN and CNS densities persisted without significant change. For overall CN and CNS density, significant associations were observed with population aging, per capita income, hospital density, hospital doctor density, hospital nurse density, and study year, whereas hospital nurse wages showed a positive but not statistically significant association. When stratified by clinical category, the directions of associations for several regional factors varied; however, hospital nurse density and hospital nurse wages tended to be positively associated with CN and CNS density in most categories. Conclusions: This study highlighted the need for targeted strategies to increase CN and CNS numbers specifically in prefectures with persistently low densities, tailored to each clinical category. Full article

Background/Objectives: The aim of this study was to evaluate the research competencies of pediatric nurses and to assess the psychometric properties of the Research Competencies Assessment Instrument for Nurses (RCAIN) in Greece. Methods: A cross-sectional study was conducted in December 2023 via a convenience population-based sample of 106 registered pediatric nurses. Eligible participants owned a diploma, bachelor’s, or graduate degree in nursing and had completed at least two years of professional service. Research competencies were estimated through the RCAIN, a standardized instrument previously validated in the Greek language. Results: The findings revealed moderate levels of research-related knowledge (mean score: 26.92/40), skills (mean score: 22.17/30), and application of research in clinical practice (mean score: 14.89/25). Higher educational attainment and participation in scientific activities were positively associated with research competency scores. The RCAIN showed high internal consistency across subscales (Cronbach’s α: knowledge = 0.914, skills = 0.905, application = 0.935), supporting its reliability in this population. Conclusions: Pediatric nurses showed moderate research competencies, underscoring the need for direct educational and institutional strategies to foster research capacity and evidence-based practice in pediatric nursing settings. Full article

Background: Music therapy is a non-pharmacological psychosocial intervention that is increasingly recognised for its role in supporting older adults in acute hospital settings. Engagement with music, whether through passive listening, preferred recorded music, live music, or creative music therapy, has been linked to improvements in behavioural, cognitive, and emotional outcomes during episodes of delirium. Although there are reviews on non-pharmacological approaches to delirium, few have focused specifically on music therapy within acute hospital environments. Methods: This scoping review examined the evidence relating to music-based interventions for older adults who are experiencing delirium or who are at risk of delirium in acute care settings. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA ScR). Four electronic databases were searched systematically, namely, CINAHL, Medline, PsycINFO and Embase. Results: Seven primary research studies published between 2004 and 2024 met the inclusion criteria. A narrative synthesis approach was used to summarise the data. Three themes were identified. The first relates to the extent to which music therapy may reduce the incidence or severity of delirium or other related behaviours in acute hospital settings. The second relates to the potential for music-based interventions to support clinical practice by improving interaction between patients and staff and reducing distress during recovery and enhancing physical recovery. The third relates to the impact of music therapy on emotional regulation, engagement, cooperation with care, and overall patient experience. Conclusion: Music therapy shows promise as a person-centred, safe, and low-cost intervention that may enhance wellbeing and support delirium care for older adults in acute hospital settings. Further high-quality studies are needed to strengthen the evidence base and guide practice. Full article

Background/Objectives: Medication incidents remain a significant concern in hospital settings. Integrated medication systems, regarding organized processes, policies, technologies and professional practices are designed to enhance patient safety; however, their safety performance is still suboptimal. The use of valid and reliable instruments to assess hospital medication system safety can be a valuable resource for health care management. The aim of this study was to describe the development and psychometric validation of the Hospital Medication System Safety Assessment Questionnaire (HMSSA-Q) for assessing the safety of hospital medication systems and its processes in Portugal. Methods: The HMSSA-Q was developed through a literature review and two rounds of expert panel consultation. Following consensus, a pilot methodological study was conducted in 95 Portuguese hospitals. Construct validity was assessed using principal component factor analysis, and reliability was evaluated through internal consistency (Cronbach’s alpha). Results: The instrument is theoretically structured into five predefined domains/subscales: Organizational Environment, Safe Medication Prescribing, Safe Medication in Hospital Pharmacy, Safe Medication Preparation and Administration, and Information and Patient Education. Principal component analyses performed separately for each domain supported their internal structure. The overall scale showed excellent internal consistency (Cronbach’s α = 0.97), with Cronbach’s alpha values for the domains ranging from 0.86 to 0.94. Conclusions: The HMSSA-Q is a valid and reliable instrument for assessing the safety of hospital medication systems and has the potential to serve as an innovative management tool for improving patient safety. Full article

Background: Patient-centered care (PCC) is a cornerstone of quality, yet its translation into managerial decision-making remains underexplored. Middle nurse managers (MNMs) play a pivotal role in enabling patient-centeredness, but their perspectives on PCC decisions are rarely investigated. Aim: This study explored MNMs’ perceptions of what constitutes a patient-centered decision in hospital settings and identified the essential dimensions underpinning such decisions. Methods: A qualitative descriptive design was adopted using semi-structured interviews. Thirty-eight MNMs from three hospitals in central Italy were included. Data were analyzed using Elo and Kyngäs’ content analysis approach. Results: Two overarching themes emerged as central to patient-centered managerial decision-making (PCMDM): “Meaning and definition of PCMDM,” and “Influencing dimensions of PCMDM”. MNMs described PCMDM as an evolving and adaptable process shaped by patient needs and organizational constraints and unfolding across distinct phases. Key influencing dimensions included the manager’s role, organizational environment, human resource management and knowledge of the patient. Conclusions: PCMDM is a continuous, ethical, and reflective process mediated by MNMs, who reconcile institutional priorities, team dynamics, and patient needs to create conditions for high-quality PCC. Implications for Practice: Strengthening PCMDM requires coordinated action aimed at equipping nurse managers with advanced leadership capabilities, building organizational structures that sustain patient-centered decisions, and empowering patients to actively co-shape the care process. Full article

Background: Integrating palliative care (PC) into primary health care (PHC) is essential for achieving Universal Health Coverage and reducing avoidable suffering. Despite global progress in PC development, the extent to which PC is effectively embedded within PHC systems remains unclear, particularly in low- and middle-income countries. Colombia illustrates this gap, with an advanced legal framework but persistent territorial inequities. This study explored how national experts conceptualize PC integration into PHC to inform the development of context-sensitive indicators. Methods: A directed thematic analysis was conducted using qualitative comments from a modified Delphi process (pre-Delphi, Round 1, Round 2). Coding was guided by the WHO model for PC development and the WHO–UNICEF Operational Framework for PHC, combining deductive and inductive approaches to identify recurrent themes. Results: A total of 230 qualitative comments from experts in PC, PHC, and public health were analyzed. Experts described integration as the alignment of policy, education, service delivery, and community participation within PHC structures. They emphasized that laws and training programs alone are insufficient; integration depends on implementation capacity, equitable access, and locally responsive systems. Rural areas were identified as facing the greatest barriers, including limited trained staff, restricted medicine availability, and weak referral pathways. Conclusions: Experts understood PC integration into PHC as a dynamic and ethical process linking system design with human experience. Strengthening equity, workforce preparation, and community engagement is essential to translate policy into practice and to develop meaningful indicators for health system improvement. Full article

Background: Rotating and night-including shifts disrupt circadian alignment, impair sleep, and may reduce nurses’ physiological recovery. Objectives: This study aimed (1) to compare sleep quality and physical well-being across four shift schedules among hospital nurses and (2) to examine whether the association between rotating shifts and physical well-being was statistically consistent with an indirect association via sleep quality. Methods: In this cross-sectional study, 173 nurses from a tertiary hospital in Zagreb, Croatia, completed validated measures of sleep quality and physical well-being. Four shift patterns were analyzed—fixed morning, morning–afternoon, extended 12-h, and rotating three-shift—using Welch ANOVA and regression models. A bootstrapped mediation analysis (10,000 resamples; BCa method), interpreted as a statistical decomposition, estimated an indirect association consistent with sleep quality. Results: Rotating-shift nurses reported the poorest sleep (PSQI = 10.2 ± 2.6; p = 0.003). Physical well-being did not differ significantly across shift types (p = 0.08), although rotating-shift nurses had the lowest mean physical scores (24.3 ± 4.4). The rotating-shift subgroup was small (n = 16), limiting precision. The mediation analysis was statistically consistent with an indirect association between rotating shifts and physical well-being via sleep quality (ACME = −1.85, 95% CI −3.05 to −0.88; p < 0.001), while the proportion of the total association was imprecisely estimated. Conclusions: In this single-site cross-sectional sample, rotating night shifts were associated with poorer sleep and, on average, lower physical well-being; patterns were statistically consistent with an indirect association via sleep quality. Because exposure, mediator, and outcome were measured concurrently, these findings are hypothesis-generating and do not establish causality. Full article

Background: Treatment nonadherence in oncology is common. Surveys often miss why patients do not follow recommendations. We synthesised Natural Language Processing (NLP) studies, mainly sentiment analysis, of patient-generated content (social media, forums, blogs, review sites, and survey free text) to identify communication and relationship factors linked to nonadherence and concordance. Methods: We conducted a scoping review (PRISMA-ScR). Searches of PubMed, CINAHL, and Scopus from 2013 to 15 June 2024 identified eligible studies. We included 25 studies. Data were charted by source, cancer type, NLP technique, and adherence/concordance indicators, then synthesised via discourse analysis and narrative synthesis. Results: Four themes emerged: (1) unmet emotional needs; (2) suboptimal information and communication; (3) unclear concordance within person-centred care; and (4) misinformation dynamics and perceived clinician bias. Sentiment analysis helped identify emotions and information gaps that surveys often miss. Conclusions: Patient-voice data suggest practical actions for nursing, including routine distress screening, teach-back, misinformation countermeasures, and explicit concordance checks to improve adherence and shared decision making. Registration: Not registered. Full article

Background: Intravenous catheterization is a common nursing procedure, although it is invasive and may cause pain and stress. Non-pharmacological interventions such as cryotherapy and thermotherapy have been explored, but practical and effective options remain limited. Purpose: This study aimed to evaluate the effects of cryotherapy and thermotherapy using the Enhanced Thermoelectric Element Tourniquet (E-TEET) a device equipped with a temperature-controlled plate and wireless charging on pain, stress, and patient satisfaction during intravenous catheterization. Methods: A randomized controlled trial was conducted involving 128 adult inpatients scheduled for preoperative intravenous catheterization. Participants were randomly assigned to one of four groups: cryotherapy (n = 31), thermotherapy (n = 31), control (E-TEET without temperature, n = 33), or comparison (latex tourniquet, n = 33). Pain and stress levels were measured using- the Numeric Rating Scale (NRS), along with pulse rate and oxygen saturation. Post-procedure satisfaction was also evaluated. Results: No significant differences were observed among the groups in terms of pain, pulse rate, or oxygen saturation. However, the cryotherapy group exhibited significantly lower stress levels and higher satisfaction compared to the comparison group (p < 0.05). Furthermore, Healthcare provider Satisfaction was significantly higher in the cryotherapy group than in the control group (p < 0.05). Conclusions: Cryotherapy using the E-TEE Tourniquet effectively reduced stress and improved satisfaction during intravenous catheterization, supporting its use as a feasible non-pharmacological intervention. Further studies are needed to standardize intervention parameters and validate findings across populations. Full article

Background/Objectives: Palliative care education is a core component of undergraduate nursing preparation; however, many nursing students report limited exposure and confidence in providing end-of-life care. Digital and web-based educational approaches have increasingly been adopted to address gaps in palliative care training and to provide flexible, scalable learning opportunities. This mixed-methods systematic review examined the use of digital and web-based approaches in palliative care education for pre-registration nursing students. The aim was to synthesize existing evidence on educational outcomes, confidence development, practice preparation, and acceptability to guide future design and implementation of technology-enhanced learning in this field. Methods: The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. The search was conducted across Medline (Ovid), Embase, CINAHL, Scopus and PsycINFO in October 2025. Studies employing qualitative, quantitative, or mixed-methods designs were eligible if they evaluated fully digital or web-based palliative care educational interventions for nursing students. Screening, quality appraisal, and data extraction were undertaken independently by multiple reviewers. Methodological quality was assessed using the Mixed Methods Appraisal Tool (MMAT). Extracted data were synthesized narratively to integrate qualitative and quantitative findings. Results: The search yielded 1826 records; after removing duplicates and applying eligibility criteria, 12 studies were included in the final synthesis. Considerable heterogeneity in design and outcomes was observed. Most included studies reported improvements in students’ knowledge, self-efficacy, and reflective capacity, alongside high levels of acceptability. Conclusions: Digital and technology-enhanced learning appears feasible and acceptable for palliative care education; however, the current evidence base is limited by methodological heterogeneity, reliance on self-reported outcomes, and predominantly short-term evaluations. Further rigorous, large-scale studies with objective outcome measures are required to determine sustained educational and practice impact. Full article

Background: A significant shortage of available organs for transplantation persists globally, with insufficient education on organ donation recognized as a key contributing factor. Allied health students, when equipped with accurate knowledge, have the potential to serve as advocates for organ donation, influencing public attitudes through their social networks. Enhancing their understanding may contribute to increased organ donation awareness and acceptance within the broader community. Methods: This study employed a quasi-experimental design to examine the effect of an educational intervention program on allied health students’ knowledge and attitudes toward organ donation and transplantation. A total of 150 allied health students were recruited through simple random sampling. Data were collected using a valid and reliable translated self-administered online questionnaire. Participants were divided into intervention and control groups. Descriptive statistics, independent sample t-tests, and one-way ANOVA were used for data analysis. Results: Following the intervention, the mean score of knowledge and attitudes in the intervention group (M = 41.09, SD = 2.57) was significantly higher than that in the control group (M = 40.29, SD = 2.40), with a t-value of −3.49 and a p-value of <0.001. These results indicate that the educational program had a statistically significant positive effect on participants’ knowledge and attitudes regarding organ donation and transplantation. Conclusions: The implementation of the educational intervention significantly improved allied health students’ knowledge and attitudes toward organ donation and transplantation. This suggests that targeted educational programs for future health professionals may be an effective strategy to promote organ donation awareness and address the shortage of organ donors. Full article

Background/Objectives: Healthcare-associated infections (HAIs) require specific skills in nursing education, yet their curricular integration often remains fragmented, limiting the consolidation of knowledge and safe clinical practice. This study aimed to explore the perceptions of nursing students from Brazil and Peru regarding the use of clinical simulation as a strategy to develop skills in HAIs prevention and control. Methods: A qualitative approach was employed, involving 12 focus groups (n = 297 students) across four universities. The discussions were conducted following simulation activities based on standardized scenarios structured into four phases: pre-reading, briefing, execution, and debriefing. Data were collected using a semi-structured interview guide flowed by content analysis, through which saturation was achieved. The study adhered to COREQ guidelines. Results: Three main themes emerged: (i) clinical simulation as a student-centered teaching–learning strategy, where pre-reading and briefing materials enhanced students’ confidence and clarity in performing tasks, with checklists suggested to avoid omissions; (ii) simulation as a facilitator of autonomy and safety in HAI prevention, offering a protected environment for making mistakes and learning, with formative feedback during debriefing increasing risk awareness, although debriefing time was noted as an area for improvement; and (iii) meaningful learning and integration with traditional education, as students reported increased engagement, better knowledge retention, and greater perceived transfer of skills to real clinical settings. Conclusions: Clinical simulation demonstrated strong potential to support the development of HAI prevention skills in undergraduate nursing students. Longitudinal implementation with standardized scenarios and further evaluation of educational effectiveness and debriefing strategies is recommended. Full article

Background: The healthcare industry demands nurses with both clinical proficiency and leadership skills. However, formal leadership training remains limited among undergraduate nursing students, underscoring the need for clinical mentorship to support leadership development. Purpose: This study investigated the association between clinical mentorship quality and leadership competencies among undergraduate nursing students enrolled at a public university in northern Saudi Arabia. Methods: Data were collected using a cross-sectional design from 224 nursing students through a self-administered online survey, which comprised three sections: demographic information, students’ perceptions of clinical mentorship quality, and a standardized assessment of leadership competencies. Results: Students reported positive perceptions of their leadership competencies, with an average score of 2.82. A strong positive correlation was observed between mentorship quality and leadership competencies, particularly in strategic thinking, emotional intelligence, influence, and teamwork. Differences were observed based on sex and academic performance, with female students and those with higher GPAs exhibiting stronger leadership competencies. Regression analysis revealed mentorship quality (β = 0.642, p < 0.001) and academic performance (β = 0.131, p = 0.013) as significant predictors of leadership competencies, while gender and academic year were not statistically significant. Conclusions: High-quality clinical mentorship substantially contributes to the development of leadership competencies among nursing students, with academic performance providing additional support. Integrating structured mentorship programs into nursing curricula may enhance preparedness for leadership roles within healthcare settings. Full article

Background/Objectives: While nurses showed a willingness to work during the pandemic and wartime, little is understood about how they managed the conflict between their roles as caregivers and personal or family obligations. They are deemed “essential workers,” risking their safety to fulfill their duties. Objectives: This study aims to explore the lived experience of nurses during COVID-19 and wartime, delving deeper into their emotional and moral experiences, providing insights for nurses and nursing management about how nurses negotiate dilemmas. Methods: A focused interpretive, hermeneutic, phenomenological approach was employed. From December 2022 to January 2023, ten hospital-based nurses from two hospitals were purposively sampled for in-depth, semi-structured interviews, which were transcribed and analyzed. The study was approved by the University Ethics Committee (31102022). Results: The essence of “ Moral Conflicts of Dual Identity and Dual Allegiance” revealed profound moral and emotional struggles among nurses. Four key themes emerged: (1) Moral Stressors and Identity Negotiation, (2) Competing Responsibilities and Ethical Double-binds, (3) Virtual and Practical Wisdom in Crises, (4) Responses of Stress and Erosion of Support Conclusions: Understanding nurses’ ethical dilemmas is essential for healthcare leadership. Leaders must make it a priority for workplace safety for their nurses. In wartime, it is not obvious that the workplace is unsafe; leaders must foster open dialog and support systems in response to these crises. This study highlights the significance of peer support, emphasizing the need for policies that address the complex moral challenges nurses face daily. Full article

Background: Due to the lack of curative treatments for inflammatory bowel disease (IBD), patients need lifelong follow-up care. Telehealth offers a valuable solution to balance routine visits with necessary monitoring. Objectives: To map what is known about the benefits and barriers encountered by nurses in their use of telehealth for the follow-up care of patients with IBD. Methods: Following the methodology from the Joanna Briggs Institute, we conducted a scoping review across four electronic databases from June 2024 to September 2025. Key search terms included “inflammatory bowel disease,” “nurse experience,” and “telehealth.” A content analysis was employed to summarize the key findings. Results: We screened 1551 records, ultimately including four original research articles from four countries. Benefits identified were as follows: (1) the vital contributions of IBD telenursing in empowering patients by bridging health literacy and self-care skills; (2) optimal use of staffing time supports patient-centred care; and (3) ease of use. Barriers included the following: (1) increased workload and task imbalances; (2) the need for customized interventions; (3) technical issues and concerns regarding the security of digital systems; (4) telehealth as a supplementary option or a standard procedure; and (5) concerns related to the patient–nurse relationship. Conclusions: Nurses view telehealth as a promising approach that enhances patients’ health literacy and self-care skills and improves patient outcomes through effective monitoring. To fully realize telehealth’s potential, implementing strategies like triage protocols, algorithmic alerts, electronic health record integration, and comprehensive nurse training to enhance patient care and engagement may be beneficial. This scoping review highlights the need for more research on nurses’ experiences with telehealth in IBD due to limited publications. Full article

Background: In recent years, interest has grown in the study of the role of the maximization trait in situations of high uncertainty and high stakes. However, although up to 13 different scales have been proposed for its measurement, none of them have been translated and validated in the Spanish language. This study addresses this gap by adapting and validating the Spanish version of the 7-item Maximization Tendency Scale, a concise instrument designed to assess the tendency to maximize, which may offer practical advantages in terms of brevity and ease of administration compared to longer scales. Objectives: We aimed to adapt and evaluate the psychometric properties of the Spanish version of the MTS-7, examining its internal consistency and factor structure when applied to a Spanish sample. Methods: A sample of 213 active nurses from the province of Cádiz (Spain) (83.5% female) completed the translated version of the MTS-7 and completed the retest two weeks later. Results: Both Exploratory and Confirmatory Factor Analyses confirmed the unidimensional nature of the scale. Cronbach’s alpha coefficient was 0.78; the 2-week test–retest reliability Pearson correlation coefficient was 0.89; ICC was 0.78. Conclusions: The Spanish version of the MTS-7 possesses satisfactory psychometric properties and proves to have adequate reliability and validity. This scale may serve as a useful tool for studying decision-making under uncertainty among Spanish-speaking nurses. Full article

Background/Objectives: The use of physical restraints in adult and pediatric intensive care units (ICUs) is common yet controversial. While restraints are intended to prevent treatment interference or self-harm, they pose significant physical, psychological, and ethical risks. Nurses in intensive care units play a key role in decisions about restraint application, but there is a global lack of validated tools to assess their knowledge, attitudes, and practices, particularly in non-English-speaking contexts. Aim of this study was to develop and validate a questionnaire for assessing knowledge, attitudes, and practices (KAP) of ICU nurses regarding restraint use in adult and pediatric settings. Materials and Methods: A multi-method psychometric validation study was conducted across both adult and pediatric ICU settings at two hospitals in northern Italy. Questionnaire development included literature review, expert consultation, and iterative content and face validity assessments. Reliability was tested using test–retest methods, and construct validity was explored through exploratory factor analysis. The study followed COSMIN guidelines. Results: The final CON-Ti-IT questionnaire comprised 29 items across three subscales: Practices, Attitudes, and Knowledge. It demonstrated strong content validity (CVI = 0.96) and good internal consistency for the Practices subscale (Cronbach’s α = 0.89). Internal consistency for the Attitudes (α = 0.51) and Knowledge (α = 0.47) subscales was lower, reflecting the broader conceptual variability of these domains. Exploratory factor analysis confirmed the structural validity of the tool and led to the removal of three items with low factor loadings. Conclusions: This study presents the first validated tool specifically designed to evaluate ICU nurses’ KAP on restraint in adult and pediatric settings. While developed and validated in Italy, it could undergo cross-cultural adaptation and translation for use in other languages and healthcare systems. Its strong psychometric properties support its application in future research, and the data collected through its use can serve both to improve patient care and to provide a foundation for targeted educational initiatives. Full article

Background: Population ageing and the growing prevalence of chronic diseases, particularly stroke, have negative repercussions on fine motor function, compromising the independence of older adults. The Specialist Nurse in Rehabilitation Nursing plays a central role in functional recovery and in improving quality of life. This study aims to describe the process of developing and validating the design of rehabilitation nursing care for older adults with impaired fine motor function. Methods: This paper is a three-phase methodological study conducted between January and July 2025: (1) initial development of the design of rehabilitation nursing care for older adults with impaired fine motor function; (2) validation of the content of the proposed design, using the modified e-Delphi technique; and (3) development of the final model of the care design. Results: The e-Delphi study, involving a panel of 15 experts, allowed the content validation of the design of rehabilitation nursing care for older adults with impaired fine motor function after two rounds. Following the suggestions, the final care design model, in relation to fine motor function, comprises five steps: (1) collection of relevant data, (2) identification of possible nursing diagnoses, (3) definition of objectives, (4) planning and implementation of interventions, and (5) evaluation of outcomes. As part of step 4, photographic records of exercises focused on the recovery of fine motor function were included. Conclusions: The final model of the design of rehabilitation nursing care for older adults with impaired fine motor function, developed and validated in this study, may serve as a guiding framework in the delivery of specialised care to this population. Full article

Background/Objectives: Workplace violence (WV) against healthcare workers (HCWs) is a major hazard all over the world. Prevention requires a reliable risk assessment. The rate of HCWs reporting a violent event varies considerably across multi-year retrospective studies compared to periodic surveys. We conducted a rapid observational study to demonstrate that data collection methods are more important than socio-cultural and healthcare organizational differences in determining the frequency of reported violence. Methods: In June 2025, in a cross-sectional observational comparison, we examined a total of 236 nurses divided into three groups: the first two were recruited online from Brescia (Italy) and Trollhättan (Sweden), while the third group was composed of Latium (Italy) nurses participating in a sleep health promotion program who answered the same questions on WV online. All the workers reported the frequency of violent incidents experienced in the previous 12 months using the Violent Incident Form (VIF), occupational stress using the Effort/Reward Imbalance questionnaire (ERI), and work ability via the Work Ability Score (WAS). Results: In the three samples, WV was correlated positively with stress and inversely with work ability (p < 0.01), while no significant difference was found between Italian and Swedish nurses in relation to the spot surveys. The nurses questioned directly about WV were significantly younger and reported significantly higher rates of physical aggression (28% vs. 5%, p < 0.001) and all forms of violence (73% vs. 20%, p < 0.001) than those questioned indirectly during the census of all the HCWs. In a multivariate linear regression model, the WV experienced and poor work ability were highly significant predictors of work-related stress (p < 0.001). Nurses who had experienced WV in the previous year had an increased odds ratio (OR = 8.94; Confidence Interval 95% = 4.43; 18.01) of reporting a state of distress. Conclusions: Experience has shown that specific questioning about violence—the commonest method used—encourages respondents to report violent events and may induce overreporting. This method also tends to involve younger workers who are more exposed to WV. On the other hand, prospective studies based on official reports may be influenced by underreporting. Monitoring WV during health promotion interventions included in occupational health surveillance could minimize both phenomena. Systematic studies and meta-analyses which rely mainly on “ad hoc” studies may be biased. Full article