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A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Healthcare Quality, Patient Safety, and Self-care Management".

Deadline for manuscript submissions: 31 July 2026 | Viewed by 18014

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Special Issue Editor

Dr. Haneen Ali

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Guest Editor

1. Department of Industrial and Systems Engineering, Auburn University, Auburn, AL 36849, USA
2. Health Services Administration Program, Auburn University, Auburn, AL 36849, USA
Interests: health services; healthcare delivery systems; Lean Six Sigma in healthcare

Special Issue Information

Dear Colleagues,

The healthcare landscape is continuously evolving, driven by advances in medical technologies, patient expectations, and policy changes. Central to this evolution is the critical role of health services and nursing quality, which significantly impacts patient outcomes, satisfaction, and the overall effectiveness of healthcare systems.

In recent years, the integration of data analytics and artificial intelligence (AI) into healthcare practices has revolutionized how nursing quality and health services are delivered. From predictive analytics to personalized care, the applications of data and AI are offering unprecedented opportunities to enhance care quality, improve efficiency, and address key challenges in patient safety.

We are pleased to invite you to contribute to this Special Issue, which aims to foster a rich dialogue that not only addresses existing challenges but also presents actionable strategies and innovative, AI-driven solutions to enhance the quality of health services and nursing care worldwide. We particularly welcome submissions from interdisciplinary teams, including healthcare administrators, nursing professionals, AI developers, and academics.

This issue aspires to be a valuable resource for advancing the field, offering key insights into how data analytics and AI can be effectively leveraged to optimize nursing care, improve health service delivery, and meet the evolving needs of modern healthcare systems, all while maintaining the highest standards of patient care.

This Special Issue aims to explore the current trends, challenges, innovations, and the transformative potential of data and AI in health services delivery and nursing care quality. We invite contributions that examine the multifaceted aspects of nursing practices, health services management, and patient-centered care, with a particular focus on improving patient outcomes, enhancing efficiency, and reducing healthcare disparities.

In this Special Issue, research areas may include (but are not limited to) the following:

Original studies and reviews;
Applications of AI and machine learning in predictive analytics for nursing outcomes;
Data-driven approaches and real-time analytics for continuous quality improvement in nursing;
Mental health and its impact on nursing practices;
Policy and regulatory frameworks shaping nursing quality standards;
Cross-disciplinary approaches to integrating data science and nursing expertise;
Patient-centered care models enhanced by AI and data analytics.

We look forward to receiving your contributions.

Dr. Haneen Ali
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

nursing quality improvement
health services management
AI in healthcare
data-driven nursing practices
patient-centered care
healthcare policy and regulation
mental health

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Published Papers (6 papers)

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Research

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17 pages, 284 KB

Open AccessArticle

Factors of the Nursing Practice Environment Shaping Nurses’ Perceived Benefits of Adverse Event Reporting: A Cross-Sectional Study Among Primary Healthcare Nurses

by Kuralai Utzhanova, Gulshara Aimbetova, Dinara Makhanbetkulova, Aurelija Blazeviciene, Nargiza Nassyrova, Akmaral Khalelova, Aizat Aimakhanova and Zhenis Mukhamedkerim

Healthcare 2026, 14(12), 1727; https://doi.org/10.3390/healthcare14121727 (registering DOI) - 16 Jun 2026

Abstract

Background: Adverse event reporting is a critical component of patient safety systems; however, nurses’ engagement in reporting is influenced not only by reporting procedures but also by broader organizational characteristics of the nursing practice environment. Although previous studies have examined reporting behaviors in various healthcare settings, limited evidence is available regarding how organizational factors influence nurses’ perceptions of adverse event reporting in post-Soviet primary healthcare systems. Objective: To examine the relationship between the nursing practice environment and nurses’ perceived benefits of adverse event reporting in primary healthcare settings in Kazakhstan and to explore the underlying factor structure of the nursing practice environment within this context. Methods: A cross-sectional survey was conducted among 468 primary healthcare nurses from six major cities in Kazakhstan. Participants were recruited through professional and educational networks using a targeted convenience sampling strategy. The nursing practice environment was assessed using the Revised Professional Practice Environment (RPPE) scale, while attitudes toward adverse event reporting were measured using the Reporting of Clinical Adverse Events Scale (RoCAES), focusing on the perceived benefits of reporting dimension. Exploratory factor analysis was performed to identify the underlying structure of the RPPE scale. Associations between EFA-derived factors and perceived benefits of adverse event reporting were examined using Spearman correlation analysis and multivariable logistic regression with adjustment for age, gender, city, and professional position. Results: Exploratory factor analysis identified three dimensions of the nursing practice environment: Professional Motivation and Teamwork, Interprofessional Conflict and Workplace Relationships, and Staffing Adequacy. Spearman correlation analysis demonstrated significant associations between all three factors and perceived benefits of adverse event reporting. Factor 1 (Professional Motivation and Teamwork) showed the strongest negative correlation with the outcome (r = −0.562, p < 0.001), followed by Factor 3 (Staffing Adequacy) (r = −0.434, p < 0.001), whereas Factor 2 (Interprofessional Conflict and Workplace Relationships) demonstrated a positive correlation (r = 0.227, p < 0.001). In the multivariable logistic regression model adjusted for age, gender, city, and professional position, Factor 1 was negatively associated with favorable perceptions of adverse event reporting (OR = 0.389, p < 0.001), whereas Factor 2 demonstrated a positive association (OR = 1.763, p = 0.002). Factor 3 and demographic variables were not statistically significant. Conclusions: The findings suggest that nurses’ perceptions of the benefits of adverse event reporting are influenced by multiple dimensions of the nursing practice environment. Exploratory factor analysis identified three organizational dimensions—Professional Motivation and Teamwork, Interprofessional Conflict and Workplace Relationships, and Staffing Adequacy—that were associated with reporting perceptions. After adjustment for demographic characteristics, Professional Motivation and Teamwork and Interprofessional Conflict and Workplace Relationships remained independently associated with perceived benefits of adverse event reporting, whereas demographic factors did not demonstrate significant associations. These findings highlight the importance of organizational conditions, communication processes, and professional engagement in shaping nurses’ attitudes toward adverse event reporting. Efforts to strengthen patient safety reporting systems should therefore extend beyond reporting procedures alone and include broader organizational strategies aimed at improving communication, teamwork, and supportive work environments within primary healthcare settings. Full article

(This article belongs to the Special Issue Health Services, Health Literacy and Nursing Quality)

15 pages, 2066 KB

Open AccessArticle

Nationwide Trends in Hospital-Acquired Pressure Ulcers, 2018–2024

by Emanuele Sebastiani, Danilo Catania, Stefano Domenico Cicala, Massimo Maurici, Michele Tancredi Loiudice and Giovanni Baglio

Healthcare 2026, 14(11), 1492; https://doi.org/10.3390/healthcare14111492 - 27 May 2026

Viewed by 196

Abstract

Aim: To estimate national incidence, temporal trends, and regional variability of hospital-acquired pressure ulcers in Italy from 2018 to 2024 using age-adjusted models and regional estimates. Design: Retrospective nationwide observational study using hospital administrative data. Methods: All Italian Hospital Discharge Records (SDOs) for adults aged ≥ 18 years with hospital stays ≥ 5 days between 2018 and 2024 were analysed. Records with pre-existing or principal diagnoses of pressure ulcer and excluded MDC/DRG categories were omitted according to adapted AHRQ PSI 03 specifications. The final dataset represented eligible hospitalizations considered at risk for hospital-acquired pressure ulcers. Crude and age-adjusted rates per 10,000 eligible discharges were estimated using logistic regression models. Results: Eligible discharges declined from approximately 1.7 million in 2018 to 1.4 million in 2020, increasing to 1.5 million in 2024. Within this population, coded hospital-acquired pressure ulcer events decreased from 3657 to 1888, then increased to 2728. Age-adjusted national rates ranged from 13.5 to 21.3 per 10,000 eligible discharges, showing temporal fluctuations during the study period, including a reduction during 2020–2021 followed by a gradual return toward pre-pandemic levels. Substantial regional variability was observed, with lower median annual adjusted rates in regions such as Friuli Venezia Giulia and Toscana and higher values in Lazio and Abruzzo. Conclusions: This nationwide analysis provides an initial descriptive overview of temporal and regional variability in coded hospital-acquired pressure ulcer events identified through an adapted PSI 03-based administrative indicator in Italy. The findings may contribute to future methodological discussion and exploratory development of nursing-sensitive indicators using national administrative healthcare databases. Implications for the profession and/or patient care: The integration of nursing-sensitive administrative indicators into national quality monitoring systems may represent an initial methodological area for future benchmarking activities, indicator validation processes, and descriptive evaluation of preventive care practices using national healthcare administrative databases. Impact (addressing): Problem: limited national evidence on hospital-acquired pressure ulcers and interregional variability in Italy. Main findings: temporal fluctuations in age-adjusted rates and persistent regional heterogeneity in coded pressure ulcer events. Impact: administrative data may represent a preliminary and exploratory source for the study of nursing-sensitive outcomes and patient safety indicators at national level. Full article

(This article belongs to the Special Issue Health Services, Health Literacy and Nursing Quality)

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22 pages, 1077 KB

Open AccessArticle

Digital Competencies for Pediatric Nurse Leaders to Sustain Patient- and Family-Centered Care: An Interpretative Phenomenological Analysis

by Alaa Hussain Hafiz

Healthcare 2026, 14(10), 1303; https://doi.org/10.3390/healthcare14101303 - 11 May 2026

Viewed by 355

Abstract

Background/Objectives: Digital systems are being increasingly used to mediate pediatric care, yet many competency models remain predominantly technical and may unintentionally dilute patient- and family-centered care. This study aimed to identify empirically grounded digital competencies that enable pediatric nurse leaders to sustain patient- and family-centered care and to propose a practice-ready competency map. Methods: An interpretative phenomenological study was conducted across three hospitals in Saudi Arabia, purposively selected for varying levels of digital maturity. Ten pediatric nurse leaders completed two in-depth, semi-structured interviews (60–90 min) and a four-week reflective journal. Data were analyzed ideographically and then across cases using interpretative phenomenological analysis. Interviews were conducted in Arabic or English; translation included professional translation, partial back-translation (30%), and bilingual review. Results: Four interlinked competency domains emerged: (1) Relational digital presence, co-viewing the electronic health record, narrating documentation, and coordinating gaze and screen use to preserve relational connection; (2) Vulnerable expertise, micro-coaching at the point of care and transparent discussion of near-misses to build psychological safety; (3) Culturally legible communication, multimodal, language-congruent communication and explicit boundaries for sensitive information; and (4) Judgment-with-data, documenting override rationales and balancing algorithmic indicators with contextual family need. Together, these domains formed a screen-side competency map translating lived experience into trainable micro-practices. Conclusions: Digital competence in pediatric nursing leadership is relational, culturally situated, and clinically interpretive rather than a linear technical checklist. Embedding these competencies into leadership development and digital workflow design may help protect and strengthen patient- and family-centered care in technology-mediated pediatric care. Full article

(This article belongs to the Special Issue Health Services, Health Literacy and Nursing Quality)

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17 pages, 567 KB

Open AccessArticle

Optimising Nursing Management: Development of a Tool to Determine Span of Control and Resource Needs of First-Line Nurse Managers in Spanish Hospitals—A Mixed-Methods Study

by Ángel Boned-Galán, Nieves López-Ibort, Ana I. Gil-Lacruz, Carmen Angustias Gómez-Baca and Ana Gascón-Catalán

Healthcare 2025, 13(17), 2215; https://doi.org/10.3390/healthcare13172215 - 4 Sep 2025

Cited by 1 | Viewed by 1524

Abstract

Background: First-Line Nurse Managers (FLNMs) have been recognised as key contributors to achieving organisational objectives, serving as vital intermediaries between management, staff, and patients. Assessing whether the Span of Control (SOC) is appropriate and providing the necessary support for FLNMs to fulfil their responsibilities poses a considerable challenge for healthcare organisations. No tool exists in Spain to guide decisions regarding FLNM’s SOC and resource needs. The aim of this study is to design a tool for assessing the span of control of first-line nurse managers in hospitals. Methods: This study employed a tool development and content validation design to create the EASOC-Nursing instrument (Eliges Aragón SOC tool). The study was conducted in three stages: an integrative literature review, followed by a national Delphi study with 43 experts in nursing management, and finally, focus group discussions. Results: A tool was created to assess first-line nurse managers’ (FLNM) span of control (SOC) using 13 key indicators, organised into four categories: unit (operations and resources, conflicts, and logging and monitoring of activities), professional (staff and competencies), FLNM (autonomy, education, and leadership), and organisation (support systems, education, and research). It includes a total of 31 items and determines SOC adequacy by establishing cut-off points that classify it as below acceptable, appropriate, or excessive. When the SOC is inadequate, the tool provides specific recommendations for support measures, such as the provision of administrative personnel or the appointment of a co-leader. Conclusions: The EASOC-Nursing tool offers a comprehensive evaluation of the core dimensions of the FLNM role and its responsibilities in Spain. Furthermore, it delivers practical guidance on the most suitable types of support to facilitate the attainment of optimal outcomes for both patients and healthcare organisations. In light of the global nursing shortage, the availability of a robust and context-sensitive instrument to assess the SOC enables hospital nursing management to allocate resources more strategically, thereby enhancing working conditions for professionals and contributing to improved patient care outcomes. Full article

(This article belongs to the Special Issue Health Services, Health Literacy and Nursing Quality)

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17 pages, 787 KB

Open AccessArticle

Assessing Stress and Shift Quality in Nursing Students: A Pre- and Post-Shift Survey Approach

by Haneen Ali and Yasin Fatemi

Healthcare 2025, 13(14), 1741; https://doi.org/10.3390/healthcare13141741 - 18 Jul 2025

Cited by 1 | Viewed by 2447

Abstract

Background: Nursing students often experience heightened levels of stress during clinical training due to the dual demands of academic and clinical responsibilities. These stressors, compounded by environmental and organizational factors, can adversely affect students’ well-being, academic performance, and the quality of patient care they deliver. Aim: This study aimed to identify the key stressors influencing nursing students’ perceptions of single-shift quality (SSQ) during clinical training and to examine how well students can predict the quality of their shift based on pre-shift expectations. Methodology: A cross-sectional survey design was implemented, collecting pre- and post-shift data from 325 nursing students undergoing clinical training in Alabama. The survey measured 13 domains related to workload, environmental conditions, organizational interactions, coping strategies, and overall satisfaction. Paired t tests and linear regressions were used to assess changes in perception and identify key predictors of SSQ. Results: This study found significant discrepancies between students’ pre- and post-shift evaluations across multiple domains, including internal environment, organizational interaction with clinical faculty/preceptors, and coping strategies (p < 0.001). Students also accurately predicted stable factors such as patient characteristics and external environment. Pre-shift expectations did not significantly predict post-shift experiences. Post-shift perceptions revealed that stress-coping strategies and collegiality were the strongest predictors of shift quality. Conclusion: Students enter clinical shifts with optimistic expectations that often do not align with actual experiences, particularly regarding support and stress management. The SSQ framework offers a valuable tool for identifying gaps in clinical training and guiding interventions that foster resilience and better alignment between expectations and real-world practice. Full article

(This article belongs to the Special Issue Health Services, Health Literacy and Nursing Quality)

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32 pages, 1219 KB

Open AccessSystematic Review

Guidelines for Reducing the Adverse Effects of Shift Work on Nursing Staff: A Systematic Review

by Alessio Danilo Inchingolo, Angelo Michele Inchingolo, Maria Celeste Fatone, Laura Ferrante, Lucia Casamassima, Irma Trilli, Francesco Inchingolo, Andrea Palermo, Grazia Marinelli and Gianna Dipalma

Healthcare 2025, 13(17), 2148; https://doi.org/10.3390/healthcare13172148 - 28 Aug 2025

Cited by 4 | Viewed by 12416

Abstract

Background: The increasing demand for care in hospital settings, often at a high intensity, requires organizing work according to 24 h shifts. Nevertheless, shift work (SW), especially at night, alters the circadian rhythm, negatively affecting the psychophysical health of nurses, compromising their quality of life, and jeopardizing patient safety. Shift-work-related diseases (SWDs) can arise from these disruptions. Methods: This systematic review aims to evaluate the effects of several types of medical, psychotherapeutic, and educational interventions and strategies on shift-work-related diseases (SWDs). The databases PubMed, Embase, Web of Science, and Cochrane were searched using the MESH terms “shift work” and “nurses” from January 2015 to March 2025. A total of 43 articles were included in the final analysis. Results: Quantitative findings from the studies showed, for example, improvements in sleep quality scores ranging from 15% to 40% with optimized shift planning, reductions in fatigue scores by 20–35% through strategic napping, and moderate effect sizes for light therapy interventions. Physical activity and relaxation techniques were associated with a 10–25% improvement in subjective well-being indices, while meal timing interventions led to reductions in gastrointestinal symptom prevalence by up to 18%. The selected articles were discussed by dividing them according to the type of intervention applied to shift nurses, namely improvement of shift planning, light and temperature modulation, introduction of napping, supplementation, meal management, psychotherapy, sleep education, physical activity, relaxation techniques and yoga, music therapy, and aromatherapy. This categorization was performed to highlight the range of strategies tested and their relative quantitative impact. Conclusions: There is evidence that SWDs can be mitigated through targeted interventions and strategies. The limitations of the studies examined include small sample sizes, extreme heterogeneity of follow-up, the few numbers of randomized controlled trials, and the prevalence of female or Intensive Care Unit nurses in study samples. Further research should focus on large-scale randomized controlled trials, multicenter longitudinal studies, and the evaluation of the most promising interventions—particularly light therapy, optimized shift scheduling, and structured napping protocols—to assess their long-term efficacy and generalizability. Full article

(This article belongs to the Special Issue Health Services, Health Literacy and Nursing Quality)

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