Nurs. Rep., Volume 16, Issue 8 (August 2026) – 36 articles

Background: Generative Artificial Intelligence (GenAI) is increasingly integrated into nursing education, yet structured AI literacy training and ethical guidance remain limited. Consequently, nursing students often rely on informal learning, resulting in variability in AI readiness, confidence, and responsible use. Aims: This study was conducted to examine (1) whether AI literacy was positively associated with AI self-efficacy and AI attitudes and (2) whether AI self-efficacy mediated the relationship between AI literacy and AI attitudes. Methods: A cross-sectional survey using convenience sampling was conducted with 100 prelicensure nursing students in New York City. Data were collected using the AI Literacy Scale (AILS), AI Self-Efficacy Scale (AISES), and Generative AI Attitude Scale (GAIAS). Correlation and path analyses were performed using SPSS and Amos 30.0. Results: The participants had a mean age of 30.25 years, and 71% were women. AI literacy and AI self-efficacy were both positively associated with AI attitudes (all p < 0.001). Path analysis showed that AI literacy significantly predicted AI self-efficacy (β = 0.39, p < 0.001) and AI attitudes (β = 0.28, p = 0.003). AI self-efficacy significantly predicted AI attitudes (β = 0.31, p = 0.001) and partially mediated the relationship between AI literacy and AI attitudes. Conclusions: AI self-efficacy partially mediated the relationship between AI literacy and AI attitudes. Nursing curricula may benefit from structured AI education that integrates guided GenAI practice, case-based learning, and faculty feedback. Such educational frameworks warrant further empirical investigation regarding their potential to foster AI literacy, AI self-efficacy, and positive attitudes toward responsible AI integration, particularly through longitudinal studies assessing subsequent behavioral outcomes. Full article

Background: The World Health Organization recommends exclusive breastfeeding for the first six months of life, with continued breastfeeding alongside complementary feeding up to two years or beyond. However, many mothers are unable to meet their breastfeeding expectations, resulting in a significant emotional impact shaped by social, cultural, and occupational factors. Objective: The aim of this study was to explore mothers’ perceptions and experiences of desired but unattained breastfeeding, with particular attention to its cultural–religious dimension. Methods: A qualitative descriptive study within an interpretivist paradigm was conducted between September 2024 and February 2025. Thirty women (15 Christian and 15 Muslim) receiving care from a primary care midwife in a Spanish city in North Africa participated. Data were collected through semi-structured interviews and analysed using inductive thematic analysis following Braun and Clarke’s approach. Results: Four main themes were identified: (1) emotional experiences and feelings, (2) reasons for breastfeeding discontinuation, (3) contextual and structural barriers, and (4) the influence of the social environment and support networks. Although both groups shared emotions such as guilt, frustration, and sadness, some differences were observed in how breastfeeding discontinuation was interpreted and experienced within this sample. Several Muslim participants expressed distress in relation to maternal identity and perceived maternal inadequacy, whereas several Christian participants more frequently emphasised contextual factors such as perceived lack of support or social pressure. Conclusions: The experience of desired but unattained breastfeeding is complex and may be shaped by cultural–religious context alongside individual, social, and structural factors. Integrating a transcultural approach into healthcare provision may improve emotional support and help reduce the burden of guilt and distress associated with breastfeeding discontinuation. Full article

Background and Objectives: Digitalization studies often emphasize perceived benefits while overlooking professionals who cannot determine whether digital tools are useful. This study quantified digital hesitancy among anesthesia and intensive-care professionals, examined its relationship with professional role and experience, and compared it with reported barriers and technology use. Methods: A single-centre cross-sectional survey included 161 professionals (80.1% of 201 eligible departmental staff): 55 nurses and 106 physicians. A four-item Uncertainty Index measured inability to appraise digital benefits in patient safety, clinical decisions, management, and education. Barrier Burden and Resource-Efficiency indices were also calculated. Group differences were assessed using nonparametric tests, and predictors of high uncertainty were examined by multivariable logistic regression. Results: Nurses had substantially higher uncertainty than physicians (mean Uncertainty Index 1.60 vs. 0.49, difference 1.11, 95% CI 0.80 to 1.42; p < 0.001), particularly regarding educational and clinical benefits. Reported barriers were similar across professional groups, with technical problems being the most common. Any reported prior use of training simulators, irrespective of frequency or recency, was markedly lower among nurses than physicians (1.8% vs. 47.2%; absolute gap 45.4 percentage points, 95% CI 35.2 to 55.5; p < 0.001). After adjustment, physician status remained strongly associated with lower odds of high uncertainty, whereas overall seniority was not significant. In an exploratory within-nurse analysis, uncertainty was higher among more experienced nurses, reaching its highest level among those with more than 20 years of practice (Spearman ρ = 0.49, 95% CI 0.24 to 0.68; p < 0.001); the seniority bands were small (n = 7 to 18), so this gradient is hypothesis-generating. Conclusions: Digital hesitancy was concentrated among nurses and was distinct from shared technical barriers; within nurses it was higher at greater seniority. Because patient-safety outcomes and intervention effects were not measured, targeted simulator-based training and role-specific feedback should be regarded as hypotheses for prospective evaluation alongside, rather than established alternatives to, generic infrastructure improvements. Full article

Background/Objectives: Hidradenitis Suppurativa (HS) is a chronic inflammatory skin disease associated with a significant impairment in patients’ quality of life (QoL). However, evidence on QoL assessment in HS remains fragmented, with heterogeneous instruments and domains reported. This scoping review aimed to map the assessment of QoL in individuals with HS, identify the instruments used, and describe the domains explored. Methods: This scoping review was conducted in accordance with the Arksey and O’Malley framework, as refined by Levac et al. and the Joanna Briggs Institute. A systematic search of six databases was performed between November 2025 and March 2026 to identify studies reporting QoL or patient-reported outcomes (PROs) in individuals with HS. Data were extracted and analyzed using a narrative synthesis approach. Results: A total of 21 studies met the inclusion criteria. HS was consistently associated with substantial QoL impairment across multiple domains, including physical, psychological, social, sexual, and occupational aspects. Symptom burden was a major determinant of reduced QoL, particularly pain, pruritus, malodor, and discharge. A wide range of instruments was used, with the Dermatology Life Quality Index (DLQI) being the most frequently applied. However, most tools did not adequately capture the multidimensional impact of HS. The use of HS-specific instruments was limited, and most studies adopted cross-sectional designs. Conclusions: QoL in HS is markedly compromised, but current assessment approaches are inconsistent and incomplete. Further research using comprehensive, disease-specific instruments and longitudinal designs is needed to better capture disease burden and support patient-centered care. Full article

Background: Family caregivers play a central role in supporting people with colorectal cancer (CRC) and often manage complex physical, emotional, and practical demands. However, evidence regarding their experiences and supportive care needs in Kazakhstan remains limited. This qualitative study explored caregiving experiences, caregiving burden, caregivers’ needs, and coping strategies. Methods: A qualitative descriptive design was used, involving semi-structured interviews with 21 family caregivers caring for patients with CRC. Participants were recruited purposively from the Medical Center of West Kazakhstan Marat Ospanov Medical University and outpatient clinics in Aktobe between December 2025 and March 2026. Interviews were audio-recorded, transcribed verbatim, and analyzed using inductive reflexive thematic analysis. Results: Most family caregivers of patients with colorectal cancer were women (95.2%). Five main themes developed: emotional challenges, transformation of daily life, caregiving tasks, caregivers’ needs and support gaps, and coping strategies and resilience. Diagnosis was described as a distressing experience characterized by shock, fear, and uncertainty. Caregiving substantially disrupted employment, financial stability, and family roles, often requiring work adjustment or leaving the workforce. Caregivers reported insufficient preparation for stoma care and expressed a strong need for structured training. Social isolation was common, as both caregivers and patients experienced a shrinking of their social support networks. Despite substantial burden, caregivers described adaptive responses to ongoing emotional and practical demands, and resilience was a prominent theme. Conclusions: Family caregivers of patients with colorectal cancer in Kazakhstan face interconnected emotional, informational, physical, and system-level challenges, while also drawing on resilience. The findings highlight priorities for support, including structured stoma care education, psychological services, recognition of caregivers’ roles, and improved discharge and transitional care. Full article

Background: Modifiable lifestyle behaviours, including physical activity and smoking, are important determinants of health and may influence the mental well-being of nursing professionals. However, evidence simultaneously examining these factors and their associations with sociodemographic, occupational, and mental health factors remains limited. Objectives: The aim of this study was to analyse the sociodemographic and occupational factors, as well as anxiety and depressive symptoms, associated with smoking status and physical activity among Spanish nursing professionals. Methods: A cross-sectional study was conducted between June and August 2021, including 1216 Spanish nursing professionals. Participants completed an online questionnaire assessing sociodemographic and occupational characteristics, smoking status, physical activity, and symptoms of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS). Bivariate analyses and multivariable logistic regression models identified factors associated with smoking status and physical activity. Results: Overall, 19.0% of participants were current smokers and 49.2% reported physical activity. Self-reported physical activity was positively associated with being a registered nurse, being male, being separated or widowed, living alone, and longer time working in the current service, whereas having children and current smoking were associated with lower odds of being physically active. Current smoking was less likely among older professionals, registered nurses, participants reporting physical activity, and those with anxiety symptoms. Conclusions: Physical activity and smoking showed an inverse association and were related to different sociodemographic and occupational characteristics among Spanish nursing professionals. The inverse association between anxiety symptoms and current smoking was unexpected and should be interpreted with caution. These findings may inform workplace health promotion strategies addressing physical activity and tobacco use together, while considering the specific needs of different professional groups within the nursing workforce. Full article

Background/Objectives: Chronic pain is a prevalent and complex condition associated with substantial physical, psychological, and social burden. Behavioural activation (BA), a structured psychological intervention originally developed for depression, may be relevant to chronic pain through its focus on reducing behavioural avoidance and increasing engagement in meaningful activities. Although BA has been applied in studies involving people with chronic pain, the safety and effectiveness of BA in this population have not been comprehensively synthesised. This systematic review and meta-analysis will examine the safety and effectiveness of BA for people with chronic pain. Methods: A systematic review and meta-analysis of literature evidence will be conducted. This protocol was developed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) and prospectively registered with PROSPERO (CRD420261379007). Randomised controlled trials (RCTs) evaluating BA or BA-based interventions for individuals with chronic pain will be eligible. MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Emcare, Web of Science Core Collection, Scopus and the Cochrane Central Register of Controlled Trials (CENTRAL), trial registries, and citation tracking will be searched. Two reviewers will independently screen records, extract data, and assess risk of bias using the Cochrane Risk of Bias 2 (RoB 2) tool. Where appropriate, meta-analysis will be conducted using a random-effects model. Pain intensity will be the primary outcome. Reported adverse events and other safety outcomes will be extracted and synthesised. Certainty of evidence will be assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Results: Not applicable; this is a protocol. Findings will be synthesised as specified in the Methods. Conclusions: The review will evaluate the effectiveness of BA with respect to pain intensity among people with chronic pain and examine what is known about its safety based on reported adverse events and other safety outcomes in existing trials. The review is expected to clarify the extent, consistency, and certainty of the randomised evidence on the effectiveness and safety of behavioural activation interventions for chronic pain and to identify gaps in adverse-event reporting and safety monitoring. Findings may inform clinical decision-making, intervention adaptation, and future research on BA for chronic pain. Full article

Background/Objectives: Healthy macrovascular and microvascular circulation is essential for wound prevention and healing in high-risk feet. While validated methods of assessing lower limb macrocirculation exist, microcirculation assessment often relies on subjective clinical judgement. This study aimed to determine reliability and reproducibility of laser speckle contrast imaging (LSCI) of superficial circulation in the feet of adults attending a high-risk foot clinic. LSCI was undertaken on seven regions of the foot, and then repeated 3–5 min later. Methods: LSCI measures were compared to health and clinical measures using correlations, t-tests or ANOVA, as appropriate, and intra-class correlation coefficients (ICC) used to analyse reliability measures. In a sample of 31 participants, good test–retest reliability was found (3–5 min apart), with ICC from 0.94 (95% CI 0.76–0.98) to 0.99 (95% CI 0.96–0.99). Results: A sub-group of 10 participants were available to test reproducibility one week later, with Cronbach’s alpha ranging from 0.83 to 0.97. Lower LSCI perfusion measures were significantly related to longer ulcer duration, use of a walking aid, and presence of respiratory disease or previous cerebro-vascular accident. Conclusions: These findings support the potential role of LSCI as a non-invasive method to evaluate superficial perfusion in high-risk feet. Full article

Background/Objectives: Young people’s mental health is increasingly discussed using diagnostic terms. However, limited knowledge exists about how young people describe distress and support needs. This study explored how young people with self-reported functional difficulties described challenges affecting their mental health and everyday lives. Methods: A qualitative study was conducted using 137 anonymized chat and text message contacts from BRIS (Children’s Rights in Society), a Swedish youth helpline. Contacts registered within the category “Functional Impairments” were selected through predefined inclusion criteria. The material was analysed in Swedish using Framework Analysis. Results: One overarching theme, Trying to Survive in an Emotional Storm, was identified, comprising three subthemes: Social Environment—Between Norm Pressure and the Need for Support, A Constant Struggle in the Educational System and Insufficient Parental Support—Between Desire for Help and Barriers to Understanding. Young people described challenges related to social relationships, school demands, and limited support from adults. Self-reported diagnostic labels, particularly ADHD, were used to explain and communicate distress. Conclusions: The findings suggest that distress was closely linked to social and contextual circumstances. For nurses and other mental health professionals, the findings highlight the importance of listening to young people’s narratives and supporting participation, autonomy, and meaning-making. Full article

Background: Falls are the most common hospital-acquired adverse event, leading to extended hospitalization, loss of independence, disability, and premature death. Routine fall risk assessments are time-consuming, even with limited factors. An AI-derived fall prediction model can provide more comprehensive and comparably accurate risk predictions quickly and as often as needed. Objective: To develop and validate a fall prediction model for fall risk in adult inpatients. Methods: Patient records from 2016 were extracted from the adult inpatient database, including information from the Electronic Inpatient Medication Records, SAP, and Hospital Incident Reporting System. The sample consisted of 1506 cases (1:5 faller to non-faller). The fall prediction model was trained using the following four variables: demographics, diagnosis, medications, and surgery. Data sources included the hospital’s data repository, integrating admission/discharge, pharmacy, laboratory, and incident reports. Results: The support vector machine model performed best among all tested models, achieving an AUC of 0.803, recall of 0.816, and precision of 0.440. In the validation cohort (978 patients: 163 fallers and 815 non-fallers), the fall prediction model demonstrated moderate-to-good discrimination (AUC 0.79), with accuracy of 0.67, sensitivity of 0.46, and specificity of 0.86. Compared with the nursing four-item fall risk assessment, which showed lower discrimination (AUC 0.65, accuracy 0.65, sensitivity 0.58, specificity 0.72), the fall prediction model had better specificity and overall discrimination, though the nursing tool was more sensitive in identifying fallers. Conclusions: The fall prediction model using demographics, diagnoses, medication, and surgery data predicts falls risk effectively. It enables timely, accurate risk assessments and supports preventive interventions, saving nurses’ time for direct patient care. Full article

Background: Over recent decades, Latin America has undergone significant population aging, accompanied by persistent inequalities that adversely affect healthcare access, particularly among Indigenous populations. This scoping review aimed to map and synthesize the available evidence on healthcare access for older Indigenous women in the region, identifying relevant dimensions, barriers, facilitators, and existing knowledge gaps. Methods: A systematic search was performed in scientific databases and gray literature up to 19 June 2026, including studies published between 2020 and 2026 in Spanish, English, or Portuguese. The PCC framework (Population, Concept, Context) was applied. Following a multi-reviewer selection process involving seven reviewers and data extraction using a standardized matrix, the findings were narratively synthesized in accordance with the PRISMA-ScR guidelines. Results: Eleven sources of evidence were included, representing six Latin American countries and including one regional review; qualitative approaches were the most common among the primary studies. Eight dimensions of accessibility were identified: geographic, economic, cultural, organizational, linguistic, functional, administrative, and social. Principal barriers included geographic isolation, poverty, a lack of cultural and linguistic relevance, bureaucratic hurdles, structural racism, and a scarcity of disaggregated data. Facilitators encompassed family and community networks, traditional medicine, local leadership, social programs, and technological/intercultural adaptations such as telemedicine. Compared with the Levesque framework, approachability, appropriateness, and formal system-navigation mechanisms were not clearly represented in the Latin American evidence, while engagement was insufficiently characterized. Conclusions: The findings indicate that structural and cultural barriers continue to persist. Full article

Background/Objectives: As artificial intelligence (AI) becomes increasingly integrated into healthcare, AI literacy and critical thinking disposition are recognized as important competencies for nursing students in rapidly changing clinical environments. This study aimed to examine the associations of AI literacy and critical thinking disposition with clinical competence among nursing students. Methods: A descriptive cross-sectional study was conducted with 200 nursing students with clinical practice experience who were enrolled in nine nursing colleges located in D City and K Province, Republic of Korea. Data were collected using a structured questionnaire and analyzed using IBM SPSS/WIN 25.0. Statistical analyses included descriptive statistics, t-tests, analysis of variance (ANOVA), Scheffé post hoc tests, Pearson’s correlation coefficients, and multiple regression analysis. Results: Satisfaction with clinical practice (β = 0.35, p < 0.001), critical thinking disposition (β = 0.34, p < 0.001), AI literacy (β = 0.23, p = 0.001), and academic year (β = 0.15, p = 0.009) were significantly associated with clinical competence. The model explained 40% of the variance in clinical competence (R² = 0.40, adjusted R² = 0.39, F = 26.11, p < 0.001). Conclusions: The findings indicate that critical thinking disposition and AI literacy were significantly associated with clinical competence among nursing students. Nursing education may therefore consider strategies that address both competencies. Full article

Background/Objective: Family caregivers of individuals with serious mental illness and substance use disorders experience substantial psychological burden. However, emerging evidence suggests many develop resilience and post-traumatic growth despite adversity. This integrative review synthesizes evidence on resilience, coping strategies, post-traumatic growth, and protective factors among these caregivers. Methods: The Whittemore and Knafl integrative review framework guided this synthesis. A systematic literature search was conducted across PubMed, CINAHL, and PsycINFO databases for peer-reviewed articles examining resilience, coping mechanisms, and post-traumatic growth in family caregivers of individuals with serious mental illness and substance use disorders. Qualitative, quantitative, and mixed-methods studies were included. Study quality was assessed using the Mixed Methods Appraisal Tool (MMAT). Data were extracted and analyzed using thematic synthesis to identify common patterns. Results: Multiple protective factors facilitate resilience and post-traumatic growth, including cultural values, family connectedness, religious faith, and emotional intelligence. Individual characteristics such as personality traits and decision-making styles influence adaptation outcomes. Structured interventions including psychoeducation, mindfulness practices, and peer support show initial evidence of enhancing caregiver resilience and psychological well-being, based on a single randomized controlled trial and cross-sectional associations. The caregiving experience provides opportunities for meaningful personal transformation despite significant burden. Conclusions: Family caregivers of individuals with serious mental illness and substance use disorders possess substantial capacity for positive psychological change. Healthcare professionals should implement strength-based, family-centered interventions acknowledging caregiver resilience. Future research employing longitudinal designs and investigating intervention mechanisms is essential to advance caregiver-focused mental health services. Full article

Background: Health innovation education often lacks focus on local realities and practitioner-led approaches. An international Canada-Brazil academic partnership was developed to address this gap within Brazil’s Unified Health System. Objectives: This paper examines attendees’ perceptions of a short-term, binational educational intervention and identifies perceived gaps in innovation training within a resource-constrained health system. Design: A qualitative, pedagogically focused program evaluation of a short-term binational educational intervention, using participant reflections and post-course survey responses to examine perceived learning, applicability, and curricular gaps. Settings: Two academic and clinical sites in Vitória and Salvador, Brazil. Attendees: Fifty attendees (30 in Vitória, 20 in Salvador), comprising students, faculty, and health and social care professionals. Methods: The 30 h in-person course was delivered in late November (Vitória) and early December 2025 (Salvador) and addressed ‘wicked problems’ through value proposition development, design thinking, and prototyping. Facilitated by a Canadian faculty with English–Portuguese simultaneous translation. The course’s immediate evaluation used daily reflective exercises and a final participant survey. Results: Respondents’ reflections suggested a perceived reframing of innovation from a primarily technology-oriented concept toward a human-centered, context-responsive, and systems-oriented process. Respondents also identified areas requiring further curricular attention, including financial sustainability, implementation planning, and impact evaluation. Conclusions: Findings from this immediate post-course evaluation suggest that short-term, interprofessional innovation education may support perceived shifts in how participants understand health innovation. However, because the evaluation relied on self-reported, post-course qualitative data without pre/post or longitudinal measures, findings should be interpreted as perceived learning and exploratory curricular insight rather than demonstrated competency development or sustained implementation capacity. Full article

Background: Early childhood caregivers are exposed to intensive caregiving demands and have a high risk of depression. Guided by the family stress process model and Acceptance and Commitment Therapy (ACT), this cross-sectional study examined whether psychological flexibility mediates the association between parenting stress and depression. Methods: A cross-sectional survey was conducted among 1140 Chinese primary caregivers of infants aged 0–36 months in Ya’an, Sichuan, China, from 9 October 2022 to 8 October 2025 using convenience sampling. Validated scales included the Parenting Stress Index-Short Form (PSI-SF), Acceptance and Action Questionnaire-II (AAQ-II) (Higher AAQ-II scores reflected lower psychological flexibility), and Patient Health Questionnaire-8 (PHQ-8). Hayes’ PROCESS Model 4, with 5000 bootstrap resamples, was adopted for the mediation analysis. Results: Parenting stress was positively associated with depressive symptoms (r = 0.335, p < 0.01) (weak-to-moderate effect size). Psychological flexibility exerted a partial mediating effect between the two variables, and the indirect effect accounted for 45% of the total effect. Caregivers with lower household income, lower educational level, and those caring for children aged 0–12 months reported significantly higher depression (all p < 0.05). Conclusions: Parenting stress is an important risk factor for depression, and psychological flexibility plays a significant partial mediating role in this relationship. ACT-based interventions targeting psychological flexibility may hold implications for depression among early childhood caregivers. Full article

Background/Objectives: Healthcare staff, especially nurses, face high occupational stress, yet objective biological indicators that complement self-report are not well established. We examined whether metabolic, hormonal and physiological markers act as indicators of stress and relate to anxiety, depression and burnout in nurses and other healthcare workers. Methods: We conducted a cross-sectional study of 300 hospital employees (239 in healthcare, of whom 123 were nurses; 61 non-healthcare) at a Croatian university hospital; of 329 completed questionnaires, 300 (91.2%) met the inclusion criteria and were analysed. Fasting glucose, lipids, thyroid hormones, cortisol, heart rate and blood pressure were measured; psychological status was measured using the 42-item Depression Anxiety Stress Scales (DASS-42), Maslach Burnout Inventory and Zung scale. Analyses used Mann–Whitney and Kruskal–Wallis tests, Spearman correlation, hierarchical logistic regression adjusted for age, sex, smoking and thyroid medication use, and receiver operating characteristic (ROC) analysis. Results: Healthcare workers had more favourable glucose, total and low-density lipoprotein (LDL) cholesterol than the older non-healthcare group (all p ≤ 0.003); because the groups differed substantially in age, these unadjusted differences are descriptive only. Metabolic markers correlated only weakly with distress and burnout. Within healthcare workers, elevated stress was discriminated in univariable analysis by low high-density lipoprotein (HDL) cholesterol (area under the curve (AUC) 0.72), raised triglycerides (AUC 0.67) and glucose (AUC 0.66); however, after adjustment for age, sex, smoking and thyroid medication use, none of the markers remained independently associated with elevated stress. Conclusions: In this relatively healthy hospital workforce, routinely available biological markers showed limited value as standalone indicators of occupational stress; they are exploratory rather than validated biomarkers, and require confirmation in larger, prospective, multicentre studies before they can complement—rather than replace—psychological screening in occupational-health practice. Full article

Background: Burnout, defined by emotional exhaustion, depersonalization, and reduced personal accomplishment, is a major occupational health concern among healthcare professionals. Burnout has been linked to depression, anxiety, and medical errors, but its association with suicidality in healthcare settings remains insufficiently explored. Objective: To investigate the association between burnout dimensions and suicidality among healthcare professionals, and to identify occupational and demographic factors influencing this relationship. Methods: A cross-sectional study was conducted among 195 healthcare professionals in Romania, recruited through voluntary participation in an anonymized online survey. Burnout was assessed using an adapted tool inspired by the Maslach Burnout Inventory, while suicidality outcomes included suicidal ideation, self-harm, and suicide attempts. Descriptive statistics were calculated for demographic and professional variables. Pearson correlations and multivariable linear regression analyses, adjusted for age, professional experience, and shift work, were performed to evaluate associations between burnout dimensions and suicidality. Results: Emotional exhaustion (r = 0.42, p < 0.001) and depersonalization (r = 0.37, p < 0.001) were positively correlated with suicidality, while reduced personal accomplishment was negatively correlated (r = −0.29, p = 0.002). In multivariable regression, emotional exhaustion remained the only statistically significant independent predictor of suicidality after adjustment for demographic and occupational characteristics. Younger age and rotating/night-shift work were associated with higher suicidality in unadjusted analyses but were not independent predictors after multivariable adjustment. Strong correlations between burnout dimensions and physical symptoms highlighted the interplay between psychosocial strain and somatic health. Conclusions: Burnout, particularly emotional exhaustion, was independently associated with suicidality among healthcare professionals, while depersonalization demonstrated a significant unadjusted association that did not remain statistically significant after multivariable adjustment. Younger clinicians, shift workers, and those with less experience appear especially vulnerable. These findings emphasize that burnout is a multifactorial construct with both psychological and somatic dimensions, shaped by systemic workplace stressors. These findings support further evaluation of systematic screening, organizational reforms, mentorship programs, and confidential mental health support as potential components of suicide-prevention strategies for healthcare professionals. Full article

Background: Healthcare-associated infections (HAIs) remain a major patient safety issue, and hand hygiene (HH) is a key preventive measure. Technologies providing immediate visual feedback may support HH training by allowing objective assessment of hand-rubbing technique. Methods: A multicenter quality improvement project was conducted in three hospitals in northern Italy to assess scanner-measured HH performance over time after a standardized HH training program supported by an automated visual feedback scanner, the Semmelweis Hand Hygiene System^®. Nurses and nurse aides performed scanner assessments before training (T0) and up to 6–9 months after training (T1–T4). Data included demographic variables, baseline HH knowledge, ring detection, and scanner pass/fail outcomes. Longitudinal changes were analyzed using adjusted generalized estimating equation (GEE) logistic regression models. Results: A total of 292 healthcare professionals participated in the project (69.2% nurses; mean age 42 years; 81.1% female). At baseline, 44.2% failed the scanner assessment, with dorsum areas being the most frequently insufficiently covered, and 36.0% wore rings. Across 2422 scanner assessments, pass rates improved over time. In adjusted GEE models, each additional scheduled month from baseline was associated with higher odds of passing the scanner assessment (OR = 1.18, 95% CI 1.13–1.24, p < 0.001). This association remained significant in the first-scan-only sensitivity analysis (OR = 1.16, 95% CI 1.11–1.21, p < 0.001). The association was also confirmed in a completers-only sensitivity analysis. Ring detection was associated with lower odds of passing, whereas baseline HH knowledge was not independently associated with scanner performance. Conclusions: Scanner-based immediate feedback was associated with improved scanner-measured HH technique over time. However, the quality improvement design, absence of a control group, use of the scanner as both feedback tool and outcome measure, and declining retention across follow-up assessments limit causal interpretation. Scanner-supported feedback may represent a useful adjunct to traditional HH education, but further controlled studies are needed to assess sustainability and real-world HH compliance. Full article

Background: Thai obstetric nurses follow WHO gestational weight gain (GWG) guidelines to prevent gestational diabetes mellitus (GDM). However, these Western-derived guidelines misclassify approximately 16% of Thai pregnant women, who carry excess metabolic risk at lower BMI values than Western populations. Objectives: To derive and validate Thai-specific GWG targets using Thai BMI cut-points across five BMI subgroups and assess implications for nursing practice in GDM prevention. Methods: Retrospective cohort study of 1396 Thai singleton pregnancies at a maternal and child hospital (2023–2025). GWG targets were derived as interquartile ranges (P25–P75) from a healthy-outcomes subgroup (n = 706), with validity confirmed by multivariable logistic regression and a 70:30 derivation/validation split. Results: GDM prevalence was 15.8%, with a rising crude trend that was attenuated after accounting for a mid-study change in screening protocol. Provisional Thai-specific GWG targets were underweight/normal weight 11.5–18.0 kg, overweight 9.7–18.0 kg, obesity class I 9.1–16.0 kg, and obesity class II+ 5.8–12.1 kg. Inadequate GWG in obesity class I was associated with a 3.92-fold GDM risk increase (aOR 3.92, 95% CI 2.12–7.24, p < 0.001). Adherence improved from 34.7% (IOM 2009) to 50.2% with Thai-specific targets. Conclusions: These Thai-specific GWG targets are provisional, single-centre pilot estimates. They appear clinically safe and are substantially more achievable than IOM 2009 criteria and are offered to inform BMI-appropriate antenatal counselling and to justify a multi-centre validation study, rather than as ranges that are ready for immediate national adoption. Full article

Background/Objective: Perioperative nursing care encompasses a diverse patient population with varying needs, anatomical and physiological characteristics, and differing levels of vulnerability, demanding specialized knowledge and skills. This study aims to identify key research priorities in perioperative nursing across the lifespan. Methods: A two-round e-Delphi study was conducted across three Portuguese hospitals, involving expert perioperative nurses (87 in the first round and 69 in the second). Participants rated the importance of various research topics on a 5-point Likert scale about six dimensions: (1) professional development and non-technical skills, (2) person-centered care, (3) organizational aspects and work environment, (4) patient and team safety, (5) digital innovation, and (6) patient outcomes and quality of care. Data were analyzed using mean scores, Content Validity Ratio (CVR) for initial validation, and the Coefficient of Variation (CV) to determine the level of consensus. The reporting of this study followed the DELPHISTAR (Guideline for Reporting Delphi Studies) recommendations. Results: A high degree of consensus was achieved (all CV < 0.20). The experts established a consensus on 48 components. The highest-rated priority was nurse burnout and professional satisfaction (Mean = 4.74). This was closely followed by patient safety (Mean = 4.68), team safety (Mean = 4.65), disaster response (Mean = 4.62), and emergency management (Mean = 4.58). Acute pain control and interdisciplinary communication also emerged as critical areas. Topics such as digital innovation and artificial intelligence, while valued, received lower priority scores. Conclusions: The identified priorities should direct funding toward research, education, quality improvement, and health policies. Future studies should focus on developing interventions to promote a favorable perioperative environment and optimize clinical responses to individuals’ conditions, catastrophes, and life-threatening situations across the lifespan. Full article

Background: Informed consent is an essential ethical and legal process that safeguards patient autonomy, integrity, and rights in healthcare. Although it has traditionally been associated with medical practice, the expanding scope of nursing practice and increased professional autonomy require a clearer understanding of nurses’ roles in this process. Given nurses’ continuous and close contact with patients, examining their knowledge, attitudes, and practices regarding informed consent is essential to ensure ethical standards and patient safety. Objectives: This scoping review will map and synthesize the available evidence on the knowledge, attitudes, and practices of general nurses, specialist nurses, resident nurses, and nursing students in relation to informed consent. Methods: This review will follow the Joanna Briggs Institute methodology for scoping reviews and will be guided by the PRISMA-ScR extension. A comprehensive search strategy will be applied to MEDLINE, CINAHL, Web of Science, Scopus, and Cuidatge databases. Quantitative, qualitative, and mixed-methods studies addressing nurses’ knowledge, attitudes, and practices regarding informed consent will be included. Discussion papers, reflective articles, commentaries, letters to the editor, opinion articles, books, book chapters, gray literature, and literature reviews will be excluded. Study selection and data extraction will be performed systematically, and findings will be synthesized descriptively and presented through tables and narrative analysis. Conclusions: This protocol outlines a transparent and reproducible methodology for a scoping review. It will map evidence on nurses’ and nursing students’ knowledge, attitudes and practices regarding informed consent; it will summarize the existing evidence as well. This study was prospectively registered with the Open Science Framework (OSF) on 13 May 2026. Full article

Aim/Objective: To evaluate undergraduate nursing students’ perceptions of the educational design, debriefing quality, satisfaction, and self-confidence associated with a leadership-focused high-fidelity simulation scenario involving the management of a sharps-injury event. Background: High-fidelity simulation provides structured opportunities for undergraduate nursing students to support learning of communication, prioritization, decision-making, teamwork, and leadership-related behaviors. Design: Single-group educational intervention study using post-intervention learner-reported outcomes. Methods: Fourth-year undergraduate nursing students from a public university in Brazil participated in a 15-min leadership-focused high-fidelity simulation involving the management of a sharps-injury event. After the simulation, participants completed validated instruments assessing simulation design, satisfaction and self-confidence in learning, educational practices, and debriefing. Descriptive statistics and exploratory Pearson correlation analyses were performed using complete data from all participants. Results: Fifty-six students participated in the simulation. Overall, participants reported favorable perceptions of the simulation design, satisfaction with learning, self-confidence, educational practices, and debriefing. Exploratory analyses showed positive correlations between satisfaction and active learning, high expectations, and debriefing quality, as well as between self-confidence and active learning, debriefing, and high expectations. Conclusions: Undergraduate nursing students perceived the leadership-focused high-fidelity simulation scenario as realistic, reflective, and educationally valuable. The scenario may represent a useful pedagogical strategy for introducing leadership-related behaviors in undergraduate nursing education. However, because the findings were based on self-reported perceptions collected after a single simulation activity, they should not be interpreted as evidence of objective leadership-related behaviors or transfer of learning to clinical practice. Full article

Introduction: The current shortage in the global nursing workforce underscores the importance of understanding factors associated with career choice and professional retention. This study aimed to identify background profiles among Hungarian Bachelor of Science in Nursing students and to examine their associations with career-choice patterns and perceptions of the Graduate Nursing Residency Program (GNRP). Methods: A cross-sectional online survey was conducted between 1 September 2025 and 1 March 2026 at seven Hungarian higher education institutions. Of 979 questionnaires screened, eight were excluded because of incomplete cluster-analysis data, resulting in an analytical sample of 971 students. Student background profiles were explored using TwoStep cluster analysis. The four-cluster solution was retained on the basis of model-fit change, cluster-size balance, parsimony, and substantive interpretability; the average silhouette value was 0.20, indicating weak separation. Results: Four exploratory profiles were identified: students from families with a university degree (17.3%), students with a rural healthcare orientation (37.3%), urban middle-class students (24.2%), and students with an urban mobility background (21.2%). The timing of career choice differed across profiles (p < 0.001; Cramer’s V = 0.179). Awareness of the GNRP was limited, with 69.7% reporting no prior knowledge. Perceived contribution to professional development differed statistically across profiles (p = 0.033; partial η² = 0.009), but the effect was small. Conclusions: The findings describe exploratory background profiles and modest associations rather than stable student categories or causal effects. Limited awareness and generally favorable perceptions of the GNRP suggest potential relevance for future communication and evaluation, but the present study does not establish program effectiveness. Full article

Background/Objectives: Postpartum depressive symptoms are a major maternal mental health concern associated with adverse outcomes for mothers and infants. Although biological, psychological, and social factors have been associated with postpartum depressive symptoms, limited evidence has examined their interrelationships within a theoretically grounded framework among Thai mothers. This study aimed to test a hypothesized Stress Process Model of factors associated with postpartum depressive symptoms among Thai mothers using structural equation modeling (SEM). Methods: A cross-sectional study was conducted among 462 Thai mothers attending routine 4–6-week postnatal follow-up clinics at three tertiary hospitals in Northern Thailand. Participants were recruited using proportional allocation and consecutive sampling. Data were collected between April and June 2025 using standardized measures of postpartum depressive symptoms and standardized measures of self-perceived burden, parenting stress, social support, self-esteem, mastery, and coping, together with demographic and clinical data. Data were analyzed using descriptive statistics and SEM. Results: Using the prespecified Edinburgh Postnatal Depression Scale cutoff score of ≥11, 30.95% of participants screened positive for probable postpartum depressive symptoms. The final structural model demonstrated acceptable fit to the data (χ²/df = 2.95, RMSEA = 0.07, CFI = 0.94, TLI = 0.92, and SRMR = 0.05) and explained 65.10% of the variance in postpartum depressive symptoms. Self-perceived burden and parenting stress showed significant positive direct associations with postpartum depressive symptoms, whereas social support showed significant inverse direct and indirect associations. Perinatal complications were directly associated with postpartum depressive symptoms and indirectly associated through self-perceived burden and parenting stress. Mastery also showed a significant inverse indirect association. Conclusions: The findings support theoretically specified associations consistent with the Stress Process Model. Because all variables were assessed concurrently, the identified pathways should be interpreted as statistical associations rather than evidence of temporal ordering or causal mechanisms. Full article

Background/Objectives: Nursing informatics (NI) competence is becoming increasingly essential for nursing students; however, previous research has largely relied on quantitative surveys and provided limited insights into why positive attitudes may not be accompanied by practical competence. This study examined Chinese undergraduate nursing students’ self-assessed NI competence and qualitatively explored their conceptual understanding, perceptions, and experiences related to NI and digital health. Methods: A convergent parallel mixed-methods design was employed in Guangzhou, China. Quantitative data were collected from 149 undergraduate nursing students across two nursing schools using the Chinese Self-Assessment of Nursing Informatics Competencies Scale (SANICS), whereas qualitative data were gathered from 23 students at one of the participating schools through six semi-structured focus groups. Quantitative data were analyzed using descriptive statistics and exploratory Spearman correlations, while qualitative data were analyzed thematically. Findings from both strands were integrated during interpretation using a joint display matrix. Results: The mean self-assessed NI competence score was 2.78 ± 0.54 (scale 1–5). Among the five SANICS subscales, attitudes toward NI scored highest (4.16 ± 0.76), whereas applied computer skills scored lowest (2.02 ± 0.80), confirming an attitude-competence paradox. Exploratory correlation analyses showed neither year of study nor clinical exposure was significantly associated with the total competence score, although both were negatively associated with attitudes. Three qualitative themes contextualized this paradox: (1) a fragmented conceptual understanding centered primarily on basic functions and tools; (2) positive but cautious perceptions that recognized the value of NI while expressing concerns about humanistic care; and (3) passive skill acquisition, limited hands-on learning, and insufficient awareness of higher-order informatics roles. Conclusions: In this two-school sample, students valued NI but reported limited applied and clinically situated competence. The findings suggest that curricula should move beyond generic computer courses and unstructured exposure toward practice-embedded NI education, including electronic health record simulation, digital documentation, data security, and clinically relevant digital skills. Full article

Introduction/Objective: Advanced practice nurses (APNs) play an increasingly important role in healthcare systems by expanding access to high-quality, patient-centred care. However, public understanding of the APNs’ role remains limited, particularly regarding their autonomy, leadership, and scope of practice. In Lithuania, APNs represent a relatively new professional group, and to date, no quantitative study has examined public perceptions of their role, competencies, and professional identity. Understanding these perceptions is essential for supporting the successful integration of APNs into the Lithuanian healthcare system. The aim of this study was to examine public perceptions of the role and professional identity of advanced practice nurses (APNs) in Lithuania. Methods: A quantitative cross-sectional research design was employed. Data were collected between October 2025 and January 2026 through an anonymous online questionnaire survey. Participants were recruited using a non-probability convenience sampling strategy. A total of 518 respondents participated in the study (n = 518). Data were collected using the Nursing’s Current Brand Position Scale (NCBPS) and the Nursing’s Desired Brand Position Scale (NDBPS). Data were analysed using descriptive statistics, correlation analysis, and principal component analysis (PCA). Results: The findings revealed that the public evaluates the professional image of advanced practice nurses (APNs) positively. However, it is primarily associated with traditional nursing values, particularly the perception of nursing as “a caring profession” and patient-centeredness. A statistically significant difference was found between the current and desired APN professional image across all evaluated dimensions (overall mean scores: 6.61 ± 1.67 vs. 7.68 ± 1.67; t = −18.426; p < 0.001), with the largest gap observed in perceptions of APNs as patient advocates, educational leaders, and research contributors. The desired image reflects public expectations for APNs to function as autonomous, decision-making professionals who actively represent patients’ interests. A significant positive association was identified between professional image evaluation and trust in APN competencies (r = 0.66, p < 0.001). Conclusions: Participants in the present study generally perceived the professional image of advanced practice nurses (APNs) positively, primarily associating it with caring and patient-centred care rather than leadership and strategic roles. The comparison between the current and desired professional images suggests that respondents expressed higher expectations for the APN role. Respondents reported moderately high trust in APNs, which was significantly associated with perceptions of their professional image. Full article

Background: Quality perinatal health care depends considerably on health workforce competency. Improving Maternal and Child Health Nurse (MCHN) competency is urgently needed in low–middle-income countries, especially to manage key perinatal conditions related to prevalent poor maternal health outcomes, such as pre-eclampsia and hemorrhage. Objective: This study assesses the competency of MCHNs in addressing severe pre-eclampsia and antepartum hemorrhage. Methodology: A cross-sectional study was conducted from 4 November to 10 December 2022. A structured questionnaire and clinical vignettes concerning severe pre-eclampsia and antepartum hemorrhage were administered to all available MCHNs working at a convenience sample of 80 primary-level health facilities in southern Mozambique. Participant characteristics and competency scores were described using frequency distributions or measures of central tendency, as appropriate. Mixed-effects ordinal regression was used to assess the association between participant characteristics and competency levels. All analyses were performed using Jamovi version 2.6.22 at a 5% significance level. Results: Out of 191 participants, most (61.8%, 118) were mid-level MCHNs, with an average age of 33 years (95% CI: 32.05; 34.2). The majority (82.7%, 158) provided prenatal consultation on the day of the interview, and about half (50.7%, 97) knew the national standards for prenatal consultation. MCHNs scoring above 50 percentage points on competency comprised 44.5% (95% CI: 37.4; 51.6%). A higher level of knowledge about guidelines and equipment was associated with increased odds ratios for having a higher-level competency score (OR = 2.21 for “good” vs. reference “poor” competency; 95% CI: 1.07; 4.57, p < 0.033). Conclusions: About six in 10 MCHNs in Mozambique have poor competency in addressing severe pre-eclampsia and antepartum hemorrhage. The competency level was only associated with knowledge of standards. Full article

Background/Objectives: The purpose of this nursing-led quality-improvement initiative was to strengthen organizational culture, support staff well-being, and improve patient safety by implementing an evidence-based collaboration model that redefined registered nurse (RN) and unlicensed assistive personnel (UAP) teamwork in acute care settings. Methods: Guided by transformational leadership principles, Nursing Professional Development (NPD) practitioners, nurse directors and managers, and frontline staff collaboratively redesigned communication and workflows. After piloting the process change, expansion occurred across acute care and step-down units through leader-supported team training alongside ongoing rounding, observations, and feedback cycles. The four phases of the EPIS framework of implementation science were used to implement the initiative, and data were collected via direct observation, anonymous staff surveys, and organizational retention and quality reports. Results: Across the seven units in Cluster 1 of the expansion, 335 RNs and 180 UAPs participated. Standardized communication using a structured handover tool increased from 18% to 95% with corresponding improvements in discussions of quality-related measures such as fall risk, turn schedules, and toileting. Patient safety measures exceeded threshold goals for fiscal year (FY) 2026 across falls with harm, pressure injuries, and catheter-associated urinary tract infections (CAUTI). RN and UAP retention demonstrated overall improvement, with RNs exceeding their retention goal and UAPs exceeding their goal by removing a single outlier unit. Perceptions of overall team communication throughout the shift increased for both RNs and UAPs. Conclusions: This initiative exemplifies how uniting transformational leadership with frontline staff empowerment supports inclusion, improved quality measures, and strengthened workforce resilience. This scalable framework for nurse-led transformation fosters belonging, safety, and shared outcomes across organizations. Full article

Background/Objectives: Nurses working in Anaesthesia and Intensive Care Units (AICUs) face high job demands that may negatively affect their well-being and increase turnover intention. In healthcare systems experiencing workforce shortages, such as Romania, understanding these mechanisms is essential for developing effective retention strategies. This study examined the relationship between job demands and turnover intention among Romanian AICU nurses, focusing on the mediating roles of professional fatigue and depressive symptoms. Methods: A cross-sectional survey was conducted among 1001 nurses from the AICUs of 68 Romanian public hospitals. Job demands were measured using a composite index including night shifts, long working hours, schedule changes, exposure to aggressive patients, calls from home, and alarm-related stress. Professional fatigue was assessed as subjective exhaustion after work, depressive symptoms with the Patient Health Questionnaire-9, and turnover intention as the intention to leave the workplace within 12 months. Mediation analyses were performed using PROCESS macro (Model 4) with logistic regression. Results: Job demands were positively associated with turnover intention. Higher job demands predicted increased professional fatigue and depressive symptoms, both significantly associated with turnover intention. Mediation analyses demonstrated significant indirect associations through both professional fatigue and depressive symptoms, indicating partial mediation. Conclusions: Job demands are related to turnover intention among Romanian AICU nurses both directly and indirectly through professional fatigue and depressive symptoms. Retention strategies should address not only workload reduction, but also prevention and coping interventions targeting fatigue and psychological distress. Full article

Objectives: Prospective anthropometric data on how women above and below the Asian-specific BMI ≥ 23 kg/m² cut-off differ across the maternal continuum remain limited. Because these data were collected in 2017–2018, before Thailand’s 2022 adoption of the threshold in antenatal care, this study describes central adiposity indicators in two independent cohorts of Thai women as a pre-implementation baseline. Methods: In this descriptive longitudinal dual-cohort study at a tertiary centre in Northern Thailand, 192 women formed two independent cohorts: Cohort A (pregnancy, from 12 weeks’ gestation; n = 110) and Cohort B (delivery to 24 weeks postpartum; n = 82), with no woman in both. Women were stratified by pre-pregnancy BMI (<23 vs. ≥23 kg/m²). Waist-to-height ratio (WHtR, primary) and mid-upper arm circumference (MUAC, secondary) were measured at seven timepoints and validated against 3D body scanning (r = 0.92–0.99). Results: At 12 weeks’ gestation, the ≥23 kg/m² stratum had higher WHtR (0.58 vs. 0.49; d = 1.56) and MUAC (32.52 vs. 26.19 cm; d = 1.98; both p < 0.001). Postpartum, the <23 kg/m² stratum returned to WHtR < 0.50 by Week 8, whereas the ≥23 kg/m² stratum remained above 0.50 through 24 weeks (0.56 vs. 0.48; p < 0.001). Conclusions: The ≥23 kg/m² stratum showed higher central adiposity indicators from early pregnancy and, in the separate postpartum cohort, values that remained above 0.50 through 24 weeks. Because the cohorts comprised different women, these patterns are descriptive and cannot demonstrate within-woman retention. They nonetheless suggest the cut-off may identify women who could benefit from earlier antenatal and extended postpartum nursing assessment, pending confirmation in within-woman studies. Full article