Nurs. Rep., Volume 16, Issue 9 (September 2026) – 52 articles

Background/Objectives: Hematopoietic cell transplantation (HCT) is increasingly used to treat malignant and non-malignant hematologic diseases and is associated with complex physical, psychological, and informational needs. Nurses play a central role in HCT care; however, the range, characteristics, and reported outcomes of nurse-led interventions have not been comprehensively synthesized. This review aimed to identify the types and outcomes of nurse-led interventions in adult HCT recipients and highlight gaps in evidence. Methods: The review was initially registered as a systematic review and was refined to a scoping review before final synthesis because of substantial heterogeneity in the available evidence. Studies involving adults undergoing or having received HCT were included if they evaluated interventions initiated, delivered, or coordinated by nurses and reported at least one clinical or patient-reported outcome. Multiple databases and grey literature (2015–2025) were searched. Study selection and data charting were performed independently by two reviewers. Methodological quality was assessed using the Mixed Methods Appraisal Tool, and findings were synthesized narratively. Results: Ten studies met the inclusion criteria, mostly from high-income countries. Nurse-led interventions included pre-transplant preparation, education, symptom management, physical activity and nutrition support, psychosocial care, navigation, survivorship follow-up, and advance care planning. Several studies reported improvements in self-efficacy, physical activity, symptom burden, and advance care planning documentation; however, findings for overall quality of life, infection rates, and long-term recovery were limited or inconclusive. Conclusions: Evidence on nurse-led interventions across the HCT trajectory remains limited. The mapped studies provide promising preliminary findings in selected outcome domains but are insufficient to establish intervention effectiveness. Future research should develop and evaluate rigorously designed, adequately powered, longitudinal, and multicomponent nurse-led interventions, including in resource-limited settings. Full article

Introduction: Talent management is increasingly relevant to nursing workforce sustainability, yet limited evidence has examined how nurses simultaneously perceive talent-related factors, organisational practices, and attraction and retention outcomes. Objective: The aim of this study was to examine the relationships between talent-management factors, organisational talent-management practices and perceived attraction and retention outcomes, while examining differences according to nurses’ sociodemographic and professional characteristics. Methodology: A multicentre, descriptive-correlational cross-sectional study was conducted with 1004 nurses from 29 public and private hospital organisations across Portugal. Talent management was assessed using the 87-item Talent Attitudes Questionnaire, comprising 12 subdimensions across factors, practices and organisational indicators. Results: Nurses reported favourable perceptions of talent-management factors (M = 3.34), particularly leadership competencies, but less favourable organisational practices (M = 3.02). Attraction (M = 2.27) and retention (M = 2.31) had the lowest scores, whereas perceived consequences of talent management were high (M = 3.49), indicating a discrepancy between talent recognition and perceived organisational capacity to attract and retain nurses. Attraction and retention were strongly correlated (r = 0.77), while organisational facilitators showed moderate associations with both outcomes. Sector-related differences were observed for turnover and inhibiting factors. Discussion: The findings suggest a potential talent-management translation gap, an interpretive, descriptive framing rather than a directly tested construct, whereby recognition of talent and its organisational consequences coexists with limited perceived capacity to attract and retain nurses. Conclusions: Nursing workforce sustainability requires translating talent recognition into organisational conditions that support professional development, attraction, and retention. These findings provide an integrated organisational perspective on talent management and nurse retention. Full article

Background/Objectives: Intensive care units (ICUs) are acoustically demanding environments in which nurses are continuously exposed to alarms, medical equipment, and staff activity. This study assessed ICU nurses’ perceived internal and external noise levels and their perceived noise-related adverse effects, and examined whether these perceptions differed according to demographic and work-related characteristics. Methods: A cross-sectional design was used with 244 ICU nurses in Saudi Arabia. Data were collected using a structured questionnaire adapted to assess perceived internal and external ICU noise and four effect domains (subjective, emotional, physiological, and work performance). Results: Perceived ICU noise was moderate (internal 64.68; external 64.51). Effect-domain means were 50.95 (subjective), 54.67 (emotional), 54.74 (physiological), and 51.28 (work performance). Female nurses scored significantly higher than male nurses for internal and external noise and for subjective, emotional, and physiological effects (all p < 0.05). Staff nurses, rotating-shift nurses, and nurses with <5 years of ICU experience reported higher effects in several domains; significant differences were also found by age group, marital status, and work-shift pattern. In multivariable models adjusting for all characteristics simultaneously, staff-nurse role, female gender and rotating shift remained independently associated with higher scores, whereas age group and years of ICU experience did not. Conclusions: ICU noise was perceived as a significant occupational stressor, with certain nurse subgroups reporting greater adverse effects. Healthcare organizations should prioritize comprehensive noise-reduction policies, effective alarm management, and targeted support strategies to mitigate noise-related impacts on nurses and improve the ICU work environment. Full article

Background: The neonatal microbiome plays a fundamental role in immune, metabolic, and physiological development from the earliest stages of life. Its establishment is influenced by several perinatal factors, many of which are closely related to nursing care practices. Objective: This study aimed to identify the principal perinatal factors associated with neonatal microbiome development and, secondarily, to explore their implications for nursing practice based on the available evidence. Methods: An integrative review was conducted using PubMed, Scopus, Web of Science, and CINAHL. Studies published between 2016 and 2026 involving newborns or neonates and addressing factors influencing neonatal microbiome development were considered. Following screening, eligibility assessment, and methodological quality appraisal, 14 studies were included in the final synthesis. Results: The evidence consistently identified mode of delivery, breastfeeding, and perinatal antibiotic exposure as the perinatal factors most consistently associated with neonatal microbial colonization. Vaginal delivery and breastfeeding were associated with greater abundances of beneficial bacterial genera, including Bifidobacterium, Lactobacillus, and Bacteroides, whereas cesarean delivery and antibiotic exposure were associated with reduced microbial diversity and altered colonization patterns. Emerging interventions such as vaginal microbial transfer showed promising results, although current evidence remains limited. Nursing-related practices, particularly breastfeeding support, promotion of early skin-to-skin contact, and participation in antimicrobial stewardship, were identified as key strategies for supporting healthy microbiome development. Conclusions: Current evidence suggests that nursing care may play an important role in promoting healthy neonatal microbial colonization through interventions that support physiological birth processes, breastfeeding, and appropriate antibiotic use. Further research is needed to evaluate the direct impact of specific nursing interventions on neonatal microbiome development and subsequent health outcomes. Full article

Background/Objectives: Interprofessional collaboration (IPC) between physicians and registered nurses (RNs) is essential for managing increasingly complex patient care. Although IPC is associated with improved coordination and patient outcomes, hierarchical dynamics and organisational constraints may limit RNs’ meaningful participation. This study explored physicians’ perceptions of RNs’ professional roles and contributions within IPC in hospital settings. Methods: This qualitative descriptive study used nine semi-structured focus group interviews with 42 physicians from medical units across three university hospitals in the Capital Region of Denmark, recruited through convenience sampling. Interviews focused on everyday collaborative practices, including interprofessional meetings and ward rounds. Data were analysed using inductive qualitative content analysis. Results: Physicians’ accounts of IPC with RNs were captured in four themes: RNs’ contributions are central to IPC; Cultural conditions enabling IPC; Misaligned workflows and competing responsibilities shaping IPC; and Clinical partnership and expectations of support in IPC. Conclusions: From the participating physicians’ perspectives, IPC was shaped by RNs’ experience, relational culture, and organisational conditions. Physicians described relying particularly on RNs’ sharing of information and clinical assessments that they considered important for safe and coordinated care, which they perceived as reflective of RNs’ experience. However, they perceived organisational constraints as limiting the integration of nursing perspectives into decision-making. These findings indicate areas for further investigation and potential organisational development related to RNs’ participation in IPC. Full article

Background: Pressure ulcers remain a prevalent and largely preventable adverse event across healthcare settings, particularly among people with impaired mobility and activity, and reduced self-care capacity. Although rehabilitation interventions address key risk factors for pressure ulcer development, their contributions are often implicit and fragmented in the literature. This review aims to systematically map rehabilitation interventions described in the literature for pressure ulcer prevention across healthcare settings. Methods: We conducted a scoping review following the Arksey and O’Malley framework and reported it according to PRISMA-ScR. Eight electronic databases were searched for studies published between 2015 and 2026 in English or Portuguese. Rehabilitation interventions aimed at preventing pressure ulcers were mapped and synthesised using Orem’s Self-Care Deficit Theory as an interpretive lens. Results: Eight records were included. Rehabilitation interventions spanned all three self-care systems and included repositioning, passive and active-assisted mobilisation, exercise prescription, electrical stimulation, pressure-relief manoeuvres, and education for individuals, caregivers, and professionals. Movement and activity enablement emerged as a prominent cross-cutting theme across systems, linking rehabilitation practice with transitions from dependence toward shared and autonomous self-care. Conclusions: Within multidimensional pressure ulcer prevention, this mapping identifies rehabilitation workforce interventions as an under-recognised component, contributing through movement enablement and fostering self-care capacity alongside other established preventive domains. Applying Orem’s theory highlights prevention as a dynamic, person-centred process. Given the small and heterogeneous evidence base and the absence of formal quality appraisal, these findings represent a mapping of potential contributions rather than evidence of effectiveness. Full article

Background/Objectives: Nursing-sensitive outcomes are key indicators of nursing care quality and safety. Digitalization of clinical documentation enables prospective surveillance using routine data, but real-world evidence on integrated digital, clinical record-based approaches remains limited. This pilot study assessed the feasibility of using routinely collected digital data, combined with ward-level indicators, to support nursing-sensitive outcome surveillance and to preliminarily identify factors associated with these outcomes during hospitalization. Methods: An observational pilot study was conducted at a 400-bed Italian university hospital over two months (November 2025–January 2026) across ten wards. Clinical variables, including the Blaylock Risk Assessment Screening Score (BRASS) and ward-level indicators, were extracted from the electronic medical record system. The exploratory composite endpoint of documented nursing-sensitive outcomes was modeled using multivariable logistic regression with cluster-robust standard errors and Cox proportional hazards regression. Results: A dataset comprising 1552 hospitalizations and 20,415 patient-days was assembled, with 100% completeness for socio-demographic data and 93% for BRASS. The cumulative event rate of nursing-sensitive outcomes was 7.35% (6.08 per 1000 patient-days at risk; 5.58 per 1000 total patient-days). Pressure injuries were the most frequent event (n = 67), followed by falls (n = 39) and physical restraint (n = 14). In the adjusted models, the BRASS (OR = 1.12 per point, 95% CI 1.08–1.15; HR = 1.10, 95% CI 1.07–1.13) and admission to the hospital from the emergency department (OR = 4.41, 95% CI 3.02–6.45; HR = 3.46, 95% CI 2.48–4.83) were independently associated with nursing-sensitive outcome occurrence. In a 48 h landmark analysis restricted to hospitalized patients still event-free on day 2, the BRASS association was attenuated (OR 1.07, 95% CI 1.04–1.10). Conclusions: An integrated, digital, clinical record-based approach proved feasible for prospective nursing-sensitive outcome surveillance and supports the design refinements planned for longitudinal analyses. Full article

Background/Objectives: Clinical placements are central to nursing education, but students’ experiences are shaped by the clinical learning environment, relationships with staff, autonomy, and assessment, as well as curricular design. This study explored nursing undergraduates’ lived experiences of clinical placements at the University of Las Palmas de Gran Canaria (ULPGC), their perceptions of the current placement programme, and suggestions for improvement. Methods: A qualitative, interpretative, sequential study with a hermeneutic phenomenological orientation was conducted. Eligible third- and fourth-year nursing students were recruited during the 2025/2026 academic year (N = 14). Phase 1 comprised ten individual semi-structured interviews, analysed inductively using ATLAS.ti, with descriptive co-occurrence patterns supporting the interpretative synthesis. Phase 2 consisted of a focus group with four additional students, with the data analysed deductively using the Phase 1 thematic framework. Results: Fifteen subthemes were organised into five themes: general experience, relationship with staff, autonomy and learning, structure and organisation, and assessment. Participants generally perceived their clinical placements positively, although experiences varied across settings. They associated satisfaction and learning with team inclusion, relationships with clinical staff, progressive autonomy, and supervision, while identifying challenges in placement organisation and assessment, particularly the reliance on written assignments rather than direct observation of clinical performance. Across both phases, participants’ accounts reflected interconnected relational, educational, organisational, and assessment-related dimensions. Collective discussion further elaborated these experiences and potential improvements concerning supervision, placement organisation, and assessment. Conclusions: Nursing students’ accounts suggested that clinical placement experiences reflected the interaction of relational, educational, organisational, and assessment-related dimensions. Collective reflection further elaborated these experiences and enabled potential improvements concerning supervision, placement organisation, and assessment to be discussed. These context-specific findings may inform future curricular review, although their transferability and the feasibility of the proposed improvements require evaluation in broader and more diverse student populations. Full article

Background/Objectives: Missed nursing care threatens care quality and patient safety and may reflect modifiable organizational conditions. This systematic review and meta-analysis quantified the association between the nursing work environment and missed nursing care. Methods: PubMed, Scopus, Web of Science, and APA PsycInfo via EBSCOhost were searched from inception; searches were updated and finalized on 13 July 2026. Quantitative studies examining nursing work, professional, or practice environments in relation to missed, incomplete, unfinished, omitted, or implicitly rationed nursing care were eligible. The eligibility criteria, primary total-score Pearson correlation analysis, random-effects model with restricted maximum likelihood (REML) estimation, and direction harmonization were specified before inspection of the pooled results. Additional robustness and exploratory analyses were conducted post hoc, including Hartung-Knapp adjustment, leave-one-out and influence analyses, risk-of-bias and instrument-family sensitivity analyses, alternative correlation-metric analyses, meta-regression, and small-study-effect assessments. The review was retrospectively registered in the Open Science Framework on 25 August 2026 (DOI: 10.17605/OSF.IO/J62D3); no prospective protocol was available. Results: Forty studies were included. The primary meta-analysis comprised 15 studies and 7100 participants. A more favorable nursing work environment was associated on average with less missed nursing care (r = −0.301; 95% CI −0.402 to −0.192; p < 0.001; model-based I² = 95.7%). The 95% prediction interval ranged from −0.641 to 0.139 and crossed the null, indicating substantial uncertainty about the magnitude and potentially the direction of the association in a new setting. The association remained statistically significant with Hartung-Knapp adjustment (95% CI −0.411 to −0.182; p < 0.001), and no leave-one-out model changed its direction or statistical significance. Conclusions: On average, a more supportive nursing work environment was associated with less missed nursing care. However, the very high heterogeneity and a prediction interval crossing the null indicate substantial variation across settings. The pooled coefficient therefore represents an average association rather than a universal effect, and the predominantly observational evidence does not establish that modifying the work environment will causally reduce missed nursing care. Full article

Background/Objectives: Intensive care is resource-intensive, and routine nursing hygiene contributes substantially to material consumption. This systematic review synthesised evidence comparing single-use and reusable or traditional reusable products in hygiene-related nursing care in intensive and critical care settings, considering clinical, economic, and environmental outcomes. Methods: A systematic review with structured narrative synthesis was conducted in accordance with PRISMA 2020. MEDLINE via PubMed, Scopus, Web of Science Core Collection, and CINAHL Ultimate via EBSCOhost were searched from inception to 25 August 2026. No language, date, or publication-type filters were applied at the database level. Primary empirical comparative studies and process-based life cycle assessments reporting original inventory data were eligible; English or Italian full text was required for inclusion. Two reviewers independently screened studies, extracted data, and performed design-appropriate methodological appraisal, with a third reviewer available to resolve disagreements. The review was registered in PROSPERO (CRD420261376160). Results: Eight studies were included: four quasi-experimental or before–after studies, three randomized trials, and one process-based life cycle assessment. The seven patient-based studies included 2665 participants across adult, paediatric, and neonatal intensive care settings. Environmental evidence was limited to two complementary studies from a single Australian ICU: reusable linen was associated with a 50% reduction in carbon emissions, from 7206 to 3605 kg CO₂e, and substantial reductions in landfill waste. Economic findings were product- and context-dependent; disposable bathing systems and diapers were generally less costly in the settings examined, whereas reusable linen increased overall expenditure by approximately 3%. Clinical findings showed no uniform advantage for either product category. After adjustment, linen type was not independently associated with pressure injury, bathing studies showed heterogeneous microbiological findings and no consistent physiological advantage between methods, and one neonatal before–after study reported lower probable sepsis with disposable diapers. Conclusions: Current evidence does not support a general advantage of either reusable or single-use hygiene products across intensive care. Environmental benefits were demonstrated for reusable linen, whereas economic and clinical outcomes varied by product, setting, and analytical approach. The evidence base remains small and heterogeneous, and no included study assessed clinical, economic, and environmental outcomes concurrently. Integrated comparative studies, particularly in European intensive care settings, are needed. Full article

Background/Objectives: The integration of generative artificial intelligence (AI) into healthcare has expanded the competencies required of clinical nurses. However, existing nursing informatics education programs do not adequately prepare nurses to use generative AI effectively and ethically in clinical practice. This study aimed to develop and evaluate a metaverse-based generative AI nursing informatics competency education program for clinical nurses. Methods: A randomized controlled pretest–posttest design was employed. Forty-eight clinical nurses were randomly assigned to an intervention group (n = 24) or a control group (n = 24), and 46 participants completed the study. The six-week education program was developed using the Analysis, Design, Development, Implementation, and Evaluation (ADDIE) instructional design model and Bandura’s self-efficacy theory. It was delivered through a metaverse platform using a flipped learning approach. Outcomes were measured at baseline, immediately after the intervention, and four weeks after the intervention. Data were analyzed using repeated-measures analysis of variance (ANOVA). Results: Compared with the control group, the intervention group demonstrated a significantly greater improvement in nursing informatics competency, the pre-specified primary outcome (p < 0.01), sustained at the four-week follow-up. Greater improvements were also observed for the secondary outcomes—general self-efficacy, ethical awareness of AI use, and evidence-based practice (all p < 0.01)—though these findings should be interpreted as hypothesis-generating given the absence of multiplicity adjustment. Conclusions: The metaverse-based generative AI education program improved self-reported nursing informatics competency and other key competencies among clinical nurses. Trial Registration: Clinical Research Information Service (CRIS) KCT0011821 registered on 8 April 2026. Full article

Canonical vascular diagrams do not capture patient-specific differences in vessel identity, course, depth, calibre, branching, adjacency, dynamic behaviour, or post-procedural route. This targeted narrative review with purposive publication selection had two objectives: to synthesise vascular anatomical evidence relevant to nursing and health professions practice and education, and to use that synthesis to propose an action-oriented conceptual framework. PubMed/MEDLINE and the Web of Science Core Collection were searched from inception to 2 August 2026. After exact DOI and normalised-title deduplication, 1683 unique records underwent title/abstract inspection and keyword-assisted prioritisation; 56 information-rich human anatomical, ultrasonographic, clinical, educational, and sentinel case publications were purposively retained for full-text evidence charting and narrative synthesis. The synthesis identified six interpretive anatomy-to-risk mechanisms: possible vessel misidentification, unsafe neurovascular adjacency, device–vessel mismatch, dynamic positional change, misinterpretation of anomalous central routes, and loss of patient-specific anatomical knowledge between encounters. These categories are qualitative synthesis outputs, not frequency estimates or causal effects. The literature informed VASC-N—Verify; Assess; Scan and distinguish; Choose, adapt, and confirm; and Note, notify, and nurture learning—as an author-developed conceptual framework of proposed observable behaviours. A preliminary Nursing Actionability Test and minimum reporting checklist were also developed. Patient-specific vascular anatomy becomes educationally and clinically relevant when recognition may change a decision, support proportionate verification or escalation, preserve future access, or strengthen assessment. VASC-N and the accompanying tools have not been validated; prospective content-validity, feasibility, reliability, educational-transfer, and clinical-outcome studies are required. Full article

Background/Objectives: Records through early 2026 mark 2025 as the warmest year in over 170 years. Pregnant women are among the populations most vulnerable to climate change. The objective of this study was to conduct a review that synthesizes existing knowledge on how the different dimensions of climate change are affecting the vulnerable population of pregnant women. Methods: A scoping review of reviews (PROSPERO: CRD420261400815) was conducted in the Health Sciences databases: PubMed, SCOPUS, PsycInfo, CINAHL and WOS, with no time or language restriction until February 2026. A qualitative synthesis was carried out on data extracted from the different reviews, and a frequency mapping of reported maternal and perinatal outcomes was performed. The methodological quality of the individual reviews included in this review was evaluated using the CASPe tool. Results: Air pollution primarily links to developmental issues and gestational hypertension (four reviews), while extreme heat was most frequently reported in relation to preterm birth (eight reviews). Natural disasters mostly compromise maternal mental health (five reviews), vector-borne diseases were most frequently associated with perinatal complications like low birth weight and preterm delivery (three reviews), and chemical exposure is chiefly associated with gestational diabetes (two reviews). Conclusions: Given all the maternal and perinatal outcomes reported in relation to climate change, healthcare professionals play a key role in advising pregnant women on their actual and perceived knowledge, risk perception, affective evaluation, self-efficacy, intention to adopt protective behaviors, and subsequent information-seeking behavior. Full article

Background: Patient experience has become a key component of healthcare quality assessment and improvement. Although its importance is increasingly recognized, there is a lack of standardized instruments specifically designed to assess patient experience in relation to nursing care during hospitalization. The starting point for this study is the ELIGES-Patient Experience questionnaire developed in 2024. This study aims to refine its content by incorporating the patient perspective and to evaluate its psychometric properties through a multicenter study. The final questionnaire will be intended to assess patient experience in relation to nursing care in inpatient units, providing a reliable tool for identifying opportunities for improvement and supporting person-centered care. Methods: A three-phase multicenter mixed-methods study will be conducted. First, a focus groups with expert patients will identify the key dimensions of patient experience related to nursing care during hospitalization. The initial questionnaire will then be reviewed and revised, yielding a first provisional version. Second, a national Delphi study involving expert patients will establish consensus on the questionnaire content, thereby yielding a consensus-based provisional version of the original instrument. Third, this provisional version of the questionnaire will undergo multicenter psychometric validation in six Spanish public hospitals. A pilot study will assess temporal stability and agreement, followed by administration of the provisional version to 2271 hospitalized patients to evaluate its psychometric properties. Expected Results: Following content refinement and psychometric validation, the resulting instrument is expected to provide a standardized measure of hospitalized patients’ experience of nursing care that may help identify areas for future evaluation and quality-improvement initiatives. Conclusions: Patient experience measurement lacks standardization, which hinders comparability and limits its use as a quality improvement tool. This highlights the need for instruments that are conceptually sound, methodologically robust, and operationally applicable. A distinctive feature of this protocol is the active involvement of patients throughout the entire process, in keeping with the principles of person-centered care and helping to strengthen the relationship between healthcare professionals and patients. Full article

Background/Objectives: Poor oral health, which is often overlooked in nursing homes (NHs), is associated with aspiration pneumonia. This analysis assesses the cost effectiveness of an oral hygiene intervention, “Mouth Care Without a Battle©” (MCWB), which trains NH staff to provide daily mouth care. The first year of a pragmatic cluster randomized effectiveness trial conducted in 14 NHs demonstrated a significant reduction in pneumonia incidence in intervention NHs. Methods: Because the two-year primary outcome was not statistically significant, the first-year analysis is post hoc. The incremental cost-effectiveness ratio (ICER) of costs (staff training, time spent providing mouth care, and pneumonia-related hospitalizations) to effects (reductions in pneumonia cases) over one year was estimated using bootstrapping. Results: Analyses for 1605 residents with clustering by NH show that the likelihood that MCWB is cost-saving ranges from 6.5% to 61.1% depending on whether staff are paid benefits and various levels of estimated hospital costs. Similarly, the likelihood that MCWB results in reduced pneumonia cases but with higher costs ranges from 32.0% to 86.6%. Whether MCWB is cost-effective depends on society’s willingness to pay for reduced pneumonia cases and related unmeasured benefits. These estimates may represent a lower bound of potential cost savings because analyses did not include costs of treating pneumonia if not hospitalized, ambulance transport, or the emotional costs of illness. However, other excluded costs (e.g., dental restorations) and resources required to improve fidelity could reduce the likelihood of cost savings. Conclusions: MCWB and similar interventions that improve oral health care in NHs may yield cost savings or produce benefits from the reduction in pneumonia that justify net increases in costs incurred. It is also important to consider who bears the costs (e.g., the NH) versus who reaps the benefits (e.g., healthier residents and reduced Medicare payments). Full article

Background/Objectives: Supporting everyday self-management is a central component of person-centered neurological nursing for young adults living with epilepsy. However, little is known about how young adults experience and negotiate everyday life with epilepsy during a developmental stage characterized by increasing independence and major life transitions. This study aimed to explore how young adults experience and negotiate everyday life with epilepsy. Methods: A qualitative exploratory study informed by a hermeneutic approach was conducted to explore participants’ experiences. Twelve young adults aged 18–29 years participated in individual virtual interviews. Interviews followed a semi-structured guide and were analyzed using reflexive thematic analysis to identify patterns across participants’ experiences. The study was reported according to the Standards for Reporting Qualitative Research (SRQR). Results: The analysis identified a main theme, Keeping balance on a moving platform, which captured how young adults experienced living with epilepsy as a continuous balancing act within an unpredictable condition. Participants described continuously balancing independence with vulnerability while managing seizures, cognitive challenges, and concerns related to safety and social participation. Familiar digital and non-digital tools supported everyday self-management by helping participants structure daily routines, compensate for cognitive difficulties, and maintain a sense of normality. Conclusions: Living with epilepsy in young adulthood requires continuous adaptation to cognitive, emotional, and practical challenges that extend beyond seizure control. This study extends current knowledge by showing that self-management involves continuous negotiation between independence, vulnerability, and everyday participation rather than symptom control alone. The findings provide insights into person-centered neurological nursing by highlighting the importance of individualized support for managing cognitive challenges, everyday self-management, and transitions into education, employment, and family life. Full article

Background/Objectives: Postoperative delirium is a frequent and clinically relevant complication among adult patients admitted to intensive care units (ICUs) following major surgery. It is associated with increased morbidity, prolonged hospitalization, functional decline, and greater healthcare burden. Although non-pharmacological interventions are widely recommended for delirium prevention, evidence regarding their effectiveness in postoperative critically ill adults remains heterogeneous. This systematic review aimed to evaluate the effectiveness of non-pharmacological interventions in preventing postoperative delirium in adult ICU patients. Methods: This systematic review was conducted according to PRISMA 2020 guidelines. Searches were performed in PubMed/MEDLINE, Embase, CINAHL, Cochrane CENTRAL, Web of Science, Scopus, LILACS, and Google Scholar. Eligible studies included randomized controlled trials, quasi-experimental studies, and comparative studies evaluating non-pharmacological interventions for postoperative delirium prevention in adult ICU or critical care patients. The primary outcome was postoperative delirium incidence. Secondary outcomes included delirium duration, delirium severity, ICU length of stay, and postoperative sleep quality. Studies reporting sleep-related outcomes without directly assessing delirium were included only in the qualitative synthesis as indirect supportive evidence and were not used to estimate the preventive effect on delirium incidence. Results: A total of 26 studies were included in the qualitative synthesis, of which 14 provided sufficient dichotomous data for the primary meta-analysis of delirium incidence. The remaining studies contributed qualitative evidence on non-comparable delirium outcomes, sleep-related outcomes, or the management of established delirium. Non-pharmacological interventions significantly reduced the risk of postoperative delirium compared with control conditions (RR = 0.61; 95% CI: 0.48–0.78; I² = 25.2%). Conclusions: Non-pharmacological interventions were associated with a significant reduction in postoperative delirium incidence among critically ill adult patients. The certainty of the evidence for this outcome was moderate, and an analysis restricted to randomized controlled trials produced a consistent result. Further high-quality randomized controlled trials are required to standardize intervention protocols and clarify their effects on secondary clinical outcomes. Full article

Background: Nutrition counselling during the perinatal period is an important component of midwifery care and health promotion. Existing competency frameworks recognize nutrition-related education and counselling as part of midwifery practice, while several studies have assessed midwives’ nutrition knowledge, attitudes, confidence, and self-reported practices. However, it remains unclear to what extent existing assessment approaches capture the quality of nutrition counselling as experienced by women receiving midwife-led care. Objective: This scoping review aimed to map existing tools, questionnaires, competency frameworks, checklists, and other assessment approaches related to nutrition counselling, nutrition education, and nutrition-related competencies in midwifery and perinatal care; to compare the measurement domains represented across these approaches; and to identify remaining measurement gaps. Methods: The review was conducted according to established scoping review methodology and reported in accordance with PRISMA-ScR. PubMed/MEDLINE, Scopus, Web of Science Core Collection, CINAHL, and Embase were searched from database inception to 1 July 2026 using two complementary search strategies targeting both nutrition-related assessment approaches and patient-experience/counselling-quality concepts. Eligible sources included studies or documents describing instruments, competency frameworks, questionnaires, screening tools, checklists, or other assessment approaches related to nutrition counselling within midwifery or perinatal care. Data were charted according to assessment type, target population, intended purpose, domains assessed, development methodology, validation evidence, and relevance to midwife-led nutrition counselling, and were synthesized descriptively and conceptually across assessment domains. Results: The database searches identified 186 records, of which 42 duplicates were removed, leaving 144 records for title and abstract screening. Thirty-four reports underwent full-text assessment, of which 25 were excluded, resulting in nine included reports. These reports represented a smaller number of distinct assessment tools, frameworks, and approaches because three reports evaluated or applied the same underlying instrument, the FIGO Nutrition Checklist. The included evidence comprised nutritional-risk screening, provider-focused knowledge-, attitude-, and practice-based assessment, observational approaches to counselling delivery, and a professional competency framework. Cross-cutting synthesis identified four conceptually distinct measurement levels: nutritional risk and dietary status, professional knowledge and competence, counselling delivery and implementation, and women’s experience of nutrition counselling. No eligible nutrition-specific patient-reported experience measure was identified, leaving the intersection between nutrition-specific content and woman-reported counselling experience insufficiently represented. Conclusions: Existing approaches provide fragmented assessment of nutrition-related care and do not comprehensively capture women’s experiences of midwife-led nutrition counselling. Further research should determine whether existing measures can be adapted or combined or whether a new patient-reported experience measure (PREM) is warranted. Full article

Background/Objectives: Sarcopenia can compromise mobility and self-care. This study estimated the prevalence of an operationally defined sarcopenia phenotype among older Egyptian outpatients and described characteristics relevant to nursing assessment; Orem’s Self-Care Deficit Nursing Theory framed interpretation but was not tested. Methods: This cross-sectional study consecutively recruited 320 adults aged ≥60 years from outpatient clinics at four randomly selected public hospitals in El-Beheira Governorate (August 2024–January 2025). The operational definition, based on the EWGSOP 2010 framework, combined calf circumference <31 cm as a pragmatic muscle-mass proxy with low handgrip strength and/or gait speed ≤ 0.8 m/s. Nutrition and functional independence were assessed using the BMI-based MNA-SF and Lawton-Brody IADL scale. Primary analyses comprised descriptive summaries and Wilson 95% confidence intervals; exploratory Firth-penalized logistic regression models adjusted for age and sex were sensitivity analyses. Results: The phenotype was present in 109/320 participants (34.1%; 95% CI, 29.1–39.4%). Prevalence was 2.7% at ages 60–74 years, 16.8% at 75–84 years, and 91.6% at ≥85 years. Nutritional vulnerability, IADL dependence, food insecurity, polypharmacy, and recent hospitalization were descriptively more common among participants meeting the definition. Adjusted models retained several associations but yielded an unstable reversed nutritional estimate and wide confidence intervals. Conclusions: The operational phenotype identified a clinically vulnerable outpatient subgroup relevant to nursing and interdisciplinary assessment. The proxy-based definition, clinic sampling, extreme age imbalance, and cross-sectional design preclude confirmation of sarcopenia and independent-association, prognostic, or causal inference. Full article

Background/Objectives: This scoping review aimed to map the existing evidence on the aims, characteristics, outcomes and implementation facilitators and barriers of peer-support interventions designed to promote self-management in individuals living with an intestinal ostomy. Methods: A scoping review was conducted following the Joanna Briggs Institute methodology and reported according to the PRISMA Extension for Scoping Reviews (PRISMA-ScR). A systematic literature search was conducted in December 2025 in the MEDLINE (PubMed), CINAHL (EBSCOhost) and APA PsycINFO (ProQuest) databases. Quantitative, qualitative, and mixed-methods design studies written in any language were eligible for inclusion, with no restrictions on publication date, language or geographical location. Rayyan was used for duplicate removal and reference management. A total of 944 titles and abstracts were screened independently by two reviewers. Fifty-three full-text studies were assessed for eligibility. Data were extracted and synthesised descriptively and narratively. Results: Fourteen eligible publications were included, representing a range of study designs, including randomised controlled trials (n = 6), observational (n = 2) and quasi-experimental (n = 1) designs, feasibility, and economic evaluation studies. Studies were conducted primarily in the USA (n = 7), followed by Turkey (n = 3). Most peer-support interventions aimed to improve quality of life (n = 6). Peer-support interventions varied considerably in delivery mode, duration, facilitation, and intervention content. Interventions were delivered by peers alone (n = 2) or involved peers in collaboration with healthcare professionals or as part of multicomponent interventions and included face-to-face, remote, and other delivery formats, ranging from a single visit to a four-month duration. Several publications reported improvements in quality of life and self-management. Structured intervention content was reported to facilitate implementation, whereas accessibility and technological barriers were reported to limit intervention delivery. Conclusions: Peer-support interventions may represent a promising approach for supporting self-management among individuals living with an ostomy, particularly with several publications reporting improvements in self-management related outcomes. However, these findings should be interpreted cautiously given the heterogeneity of intervention characteristics and study designs, together with the absence of critical appraisal of included publications. Future research should identify core components of peer-support interventions and evaluate their longer-term outcomes across diverse healthcare and cultural contexts. Full article

Background/Objectives: Women undergoing endocrine therapy after breast cancer often experience sexual-health concerns, but opportunities for individualized nursing support are limited. This case series implemented and preliminarily evaluated a novel sexual health-care model for women undergoing endocrine therapy after breast-cancer treatment. Methods: A care model was developed from Comfort Theory, a literature review, and clinical experience and underwent content-validity review by experts, including one nurse with lived experience of breast cancer. It was implemented individually for 6 months in five premenopausal women receiving endocrine therapy after breast-conserving surgery or total mastectomy. Data included baseline characteristics, care records, final interviews, and Self-affirmation Scale scores. Nursing goal attainment and final interviews were evaluated qualitatively. Results: All nursing goals appeared to have been achieved based on provider assessment and participants’ narratives. Participants gradually expressed distress, questions, and sexual health needs related to bodily and sexual changes, developed greater understanding of treatment-related changes, identified individualized coping strategies, and showed greater self-worth and self-care. Self-affirmation scores were descriptively higher after care. Phenomenological analysis identified four constituents: having a place to discuss a body marked by breast and fertility loss; sharing with a midwife who accepted them as they were; reconnecting with their changed bodies; and discovering new meaning in life with altered fertility and bodily integrity. Conclusions: The care model may provide a safe, individualized space for women undergoing endocrine therapy after breast cancer to express concerns, understand bodily changes, and reconstruct meaning. The findings are preliminary and represent provider-assessed observations rather than evidence of effectiveness. Full article

Background/Objectives: Exercise intolerance is clinically important but conceptually unstable in cardiovascular care. Its relationship with exercise tolerance, exercise capacity, functional capacity and the nursing concept of activity intolerance remains unclear, and the term entered nursing from other disciplines without corresponding conceptual scrutiny. This protocol will examine how these concepts are used in adults with cardiovascular disease, how use varies across conditions, care settings, pathway phases and time, and which attributes, antecedents, consequences and related concepts are reported, to determine what these concepts can mean for nursing. Methods: The study has two interconnected phases: a scoping review following Joanna Briggs Institute methodology and PRISMA-ScR and PRISMA-S reporting, followed by Rodgers’ evolutionary concept analysis. Searches will cover MEDLINE, CINAHL, Embase, Web of Science and Scopus, complemented by gray literature and standardized nursing terminologies. Expected Results: The review will map how exercise intolerance, activity intolerance and neighboring terms are used and will chart which defining attributes and empirical referents are recognizable through routine nursing assessment, require instrumented testing or both. Whether a stable nursing formulation can be derived is treated as an open question: convergence, divergence, instability and insufficient evidence are all possible, and attributes recognizable only through instrumented testing will be reported as a null result for nursing operationalization. Conclusions: The review will determine how the concept has evolved for the discipline of nursing and whether nursing assessment can operationalize it. It will not establish professional consensus, diagnostic thresholds, measurement validity or device specifications. Registration: This study was registered in the Open Science Framework (OSF) Registries before screening and data charting commenced. Full article

Background/Objectives: Postoperative thirst is a common and distressing symptom among surgical patients; however, standardized management guidelines remain limited. Oral care interventions using cold stimulation (e.g., ice chips, popsicles, and menthol-infused products) may relieve postoperative thirst, but variation in intervention protocols and outcome measures has so far precluded clear clinical recommendations. This protocol outlines a systematic review evaluating the effectiveness of cold-stimulation oral care interventions in reducing thirst intensity among adult surgical patients during the immediate postoperative period, defined as the first 6 h after emergence from general anesthesia. Methods: Randomized controlled trials (RCTs) comparing cold-stimulation oral care with standard care will be included; as pre-specified at registration, quasi-randomized trials will be considered only if fewer than three eligible RCTs are identified (appraised with ROBINS-I and reported separately). MEDLINE, Cochrane Library, EMBASE, CINAHL Plus and trial registries were searched. Risk of bias will be assessed using the Cochrane Risk of Bias tool version 2.0. The primary outcome is change in thirst intensity; secondary outcomes are oral dryness, patient satisfaction, and adverse events. Continuous outcomes will be pooled as mean differences, or as standardized mean differences across differing scales, and dichotomous outcomes as risk ratios, with 95% confidence intervals. Random-effects meta-analysis will be performed in R where appropriate, otherwise narrative synthesis, with pre-specified subgroup and sensitivity analyses. Certainty of evidence will be rated using GRADE. Conclusions: This protocol was developed in accordance with PRISMA-P and prospectively registered in PROSPERO (CRD420251139881). The review will clarify the effectiveness and safety of cold-stimulation oral care for postoperative thirst and support perioperative nursing practice. Full article

Background/Objectives: Nursing diagnoses (NDs) support clinical reasoning, individualised care planning, and the visibility of nursing practice, yet their implementation remains inconsistent. This study prospectively examined whether TPB-informed beliefs, attitudes towards NDs, behavioural intention, and the nursing practice environment were associated with initial ND use and subsequent documentation intensity. Methods: A prospective observational cohort study was conducted across 14 adult inpatient units within a public healthcare organisation in Northern Italy. Baseline questionnaire data were linked with electronic nursing records, workforce data, and ward-level administrative data. Initial use was defined as documentation of at least one ND during follow-up. Results: The primary cohort included 144 nurses, of whom 122 (84.7%) documented at least one ND. Greater work exposure was associated with initial use (OR = 1.71, 95% CI [1.12, 2.60]). After additional adjustment for the overall PES-NWI, behavioural beliefs (OR = 1.93, 95% CI [1.09, 3.40]) and normative beliefs (OR = 2.09, 95% CI [1.16, 3.76]) were associated with initial use after multiplicity correction. These associations were attenuated and non-significant in the sensitivity cohort. Control beliefs, attitudes, and behavioural intention showed no consistent associations with initial use. No personal determinant was associated with documentation intensity. The nursing practice environment was not independently associated with either outcome. Conclusions: Initial ND use was associated with work exposure and, in the primary cohort, with behavioural and normative beliefs. Baseline individual and organisational factors did not explain documentation intensity, supporting a distinction between initiation and subsequent extent of use. Full article

Background/Objectives: Person-centered care (PCC) and the Technological Competency as Caring in Nursing (TCCN) theory are increasingly emphasized in nursing leadership, but no published study has evaluated a PCC/TCCN training program among Mongolian nurse managers. This uncontrolled, single-group pilot pre–post study examined immediate changes in nurse managers’ self-reported PCC and TCCN perceptions following a one-day collective training program. Methods: The program was delivered on 30 October 2025 during the 2nd International Nursing Symposium in Mongolia. Using convenience sampling, hospitals were invited to send nurse managers who were currently in post or senior nurses who had been formally nominated for such a role. Of 50 attendees, 30 met a pre-specified role-eligibility criterion and formed the matched pre–post analytic sample. Participants completed Mongolian versions of the Person-Centered Care Instrument (PCCI) and the Perceived Technological Competency as Caring in Healthcare Providers Instrument (TCCHI) immediately before and after the program. Pre–post differences were assessed with Wilcoxon signed-rank tests, effect sizes for the Wilcoxon signed-rank test (r = z/√N), and Holm–Bonferroni correction across 16 comparisons. Results: Total and all concept-level PCCI and TCCHI scores were higher after the program than before it, all 16 comparisons remained significant after correction, and the effect sizes were moderate to large (r = 0.41–0.61). The median within-person change was +22.0 points (95% CI 7.0 to 35.5) for the total PCCI score and +24.0 points (95% CI 10.5 to 38.0) for the total TCCHI score (Hodges–Lehmann estimates). Conclusions: In this small convenience sample of Mongolian nurse managers and senior nurses formally nominated for managerial roles, self-reported PCCI and TCCHI scores increased immediately after a one-day training program. Because the study used a single-group design without a control group, employed instruments not yet fully validated in Mongolian, and included no follow-up, these findings are preliminary evidence of an association rather than proof of program effectiveness. Larger, controlled studies with follow-up are needed. Trial Registration: TCTR20260513001, registered retrospectively on 13 May 2026, after data collection had been completed. Full article

Introduction: Dating violence is an early form of intimate partner violence characterized by controlling behaviors, psychological and sexual abuse, and digital coercion. Despite its high prevalence among adolescents and young adults, it remains underrecognized and insufficiently addressed in healthcare settings. Nurses are strategically positioned to identify and respond to dating violence due to their close contact with patients and holistic approach to care. However, important gaps remain between existing protocols and their implementation in clinical practice. Methods: An exploratory qualitative study was conducted within a constructivist paradigm as part of a multicenter research project on dating violence among health sciences university students. Twelve experts, including nurses, healthcare professionals, and representatives of survivor-led organizations, participated in focus groups and reflective journals between September and December 2025 at the University of Barcelona. Data were analyzed using an interpretative phenomenological approach, with inductive thematic analysis guiding coding and theme development. Methodological rigor was ensured following the Consolidated Criteria for Reporting Qualitative Research (COREQ). Ethical approval was obtained. Results: Four themes emerged: (1) barriers to identification, including the normalization of controlling behaviors, myths of romantic love, and limited recognition of psychological and digital violence; (2) challenges in nursing responses, such as insufficient training, clinical uncertainty, organizational barriers, and lack of screening tools; (3) identification strategies, including systematic screening, relationship-centered interviewing, emotional education, and recognition of subtle warning signs; and (4) actions following identification, focused on validation, confidentiality, risk assessment, interdisciplinary referral, and ongoing support. Conclusions: Findings highlight the need to update protocols to explicitly address digital violence and strengthen nursing-led interventions. Participants emphasized the need for enhanced professional training, context-appropriate screening tools, and intersectoral collaboration as potential strategies to improve the identification and response to dating violence. Full article

Background: In the wake of the COVID-19 pandemic, nursing students and educators are navigating an increasingly complex academic environment. The rigorous demands of nursing education, combined with diminished academic preparedness and growing mental health concerns, have heightened the need for effective wellness interventions. The SKY Happiness Retreat©, an evidence-based program incorporating breathwork, meditation, and mindfulness practices, offers a potential strategy to enhance student resilience and reduce stress. Purpose: This pilot study examined the impact of integrating the SKY Happiness Retreat© into a Bachelor of Science in Nursing (BSN) program. This study evaluated whether participation reduced perceived stress and improved students’ ability to manage stressful situations. Methods: A quasi-experimental pretest–post-test design was used with junior-level BSN students recruited through convenience sampling at a rural university. Participants completed a structured three-day retreat focused on breathwork, meditation, and mindfulness. Outcomes were measured using the Mood and Anxiety Symptom Questionnaire (Mini-MASQ), the Perceived Stress Scale (PSS), and the Brief Resilience Scale (BRS). Results: Perceived stress significantly decreased following the intervention (PSS: pre M = 18.50, SD = 4.583; post M = 17.30, SD = 5.841; t(43) = 2.072, p = 0.022). General distress also significantly improved (Mini-MASQ: pre M = 15.51, SD = 6.535; post M = 12.82, SD = 5.118; t(44) = 3.941, p < 0.001). No significant changes were observed in anxious arousal or anhedonic depression. BRS scores demonstrated a modest increase in resilience. Conclusions: The SKY Happiness Retreat© shows promise as an experiential learning strategy within undergraduate nursing education. Findings suggest participation was associated with reductions in perceived stress and general distress while promoting resilience. Integrating evidence-based wellness programs into prelicensure nursing curricula may better prepare students to manage academic and professional stress. Larger, longitudinal studies are needed to evaluate long-term effectiveness. Full article

Background/Objectives: Securement of oral endotracheal tubes (ETTs) is a critical component of airway management in mechanically ventilated adults. Inadequate fixation may lead to tube displacement, and device-related pressure injuries. The aim of the study was to evaluate the effectiveness and safety of different oral ETT securement evidence in adults. Methods: A comprehensive search was conducted on seven English and Chinese databases (Cochrane Library, PubMed, CINAHL, Web of Science, EMBASE, Airiti Library and CNKI) to identify clinical trials evaluating the effectiveness and safety of different oral endotracheal tube securement methods. Methodological quality of the trials was assessed using the Cochrane Risk of Bias 2 (RoB 2.0) and the Joanna Briggs Institute (JBI) tools. A frequentist network meta-analysis was performed to estimate odds ratios with 95% CIs. The review protocol was registered with INPLASY (INPLASY202480089). Results: A total of 45 studies published between 1993 and 2022 (17 in English and 28 in Chinese) met the inclusion criteria. Compared with adhesive tape, ETT holders (OR 0.15, 95% CI 0.08–0.27) and twill (OR 0.25, 95% CI 0.11–0.59) significantly reduced tube displacement, with no difference between them. For pressure injury, ETT holders showed a significantly lower risk compared with adhesive tape (OR 0.33, 95% CI 0.15–0.70), while evidence for twill was inconclusive. No major inconsistency was detected for pressure injury, whereas inconsistency could not be assessed for tube displacement because the network contained no closed loops. Conclusions: Both twill and ETT holders were more effective than adhesive tape in reducing oral ETT displacement. ETT holders demonstrated more consistent benefits across outcomes and significantly reduced the risk of device-related pressure injury, suggesting they may be the preferred securement method for mechanically ventilated adults. Further high-quality head-to-head trials are needed to strengthen the current evidence. Full article

Background/Objectives: Immersive virtual reality (VR) is increasingly used during pediatric procedures, but intervention effects vary across children, procedures, devices, comparators, and outcomes. This review synthesized recent evidence and developed a proposed developmentally informed child-procedure-intervention framework for clinical matching. Methods: A structured narrative review synthesized 96 publications identified through PubMed, Scopus, Web of Science Core Collection, the Cochrane Library, and CINAHL through 31 July 2026. Explicit searching, eligibility criteria, screening, and structured evidence characterization were used to improve transparency; however, this was not a systematic review, and no formal risk-of-bias or certainty-of-evidence assessment was performed. Evidence was interpreted according to publication type and organized by clinical context, developmental modifiers, intervention characteristics, implementation, biofeedback, and future AI-supported decision support. Results: The most recurrent favorable findings concerned venipuncture, intravenous access, vaccination, and related needle procedures, particularly against usual care, whereas comparisons with active distraction and evidence from oncology, burns, dentistry, orthopedics, surgery, and emergency care were more mixed. The narrative synthesis identified developmental readiness, baseline anxiety, previous procedural experience, sensory tolerance, content, interactivity, immersion, timing, comparator, concurrent analgesia, and patient preference as plausible moderators, although their predictive value remains insufficiently validated. The author-generated framework links nursing assessment, purpose-based VR selection, monitoring, stopping criteria, and clinically approved adjustment. Conclusions: Pediatric procedural VR should not be treated as a uniform intervention. The proposed framework is evidence-informed and hypothesis-generating, not a validated clinical decision model. Biofeedback is supported by preliminary pediatric evidence, whereas AI-supported adaptation remains a future research and translational opportunity requiring prospective validation, governance, and continuous clinical oversight. Full article

Background/Objectives: Chronic diseases place sustained pressure on primary care systems worldwide. While artificial intelligence (AI) shows promise for supporting chronic disease management in primary care, the factors influencing its adoption and implementation have not been comprehensively addressed within the specific context of primary care chronic disease management. The aim of the scoping review was to identify the key drivers that influence AI adoption in primary care settings for chronic disease management. Methods: This scoping review was conducted following the PRISMA ScR guidelines. A comprehensive search of seven databases was conducted between 14 April and 14 May 2025, with an updated search on 27 February 2026 using the same search strategy and eligibility criteria. Eligible studies examined the adoption or implementation of AI for chronic disease management in primary care and were published in English from 2010 to 2026. Data were charted using a standardised extraction tool and synthesised narratively. The protocol for this scoping review was registered with INPLASY. Results: Twenty-two studies were included, identifying five domains influencing AI adoption. Technical factors included data quality, interoperability, and algorithm transparency. Human factors related to clinician trust, workload, digital literacy, and preferences for hybrid human–AI care. Legal and ethical considerations centred on privacy, accountability, fairness, and independent validation. Organisational factors involved leadership, workflow integration, and resourcing, while geographical and cultural contexts shaped readiness, acceptability, and equity. Conclusions: AI adoption in chronic disease management within primary care is shaped by multi-level, context-dependent factors. The findings suggest that implementation may require coordinated strategies encompassing robust data governance and interoperability, clear regulatory frameworks, workforce capability development, workflow-aligned hybrid models with appropriate human oversight, and sustainable resourcing and reimbursement. Future research should extend beyond technical performance to evaluate acceptability, safety, workload, equity, and longer-term organisational impacts. Full article