Nursing Reports

Background: Violence against healthcare professionals is a growing public health concern. In Spain, the National Observatory of Aggressions recorded 16,866 cases in 2024, marking a 103.06% increase since 2017. This phenomenon has intensified in recent years, with serious repercussions for both the physical and psychological well-being of healthcare workers, as well as for the quality of care provided. Objectives: This descriptive study examines the knowledge, perceptions, and experiences of workplace aggression among undergraduate students at the University School of Nursing of the Nuestra Señora de Candelaria University Hospital. Materials and Methods: A self-administered ad hoc questionnaire was distributed to 266 students across all academic years to assess their knowledge and to explore their perceptions and experiences of aggression witnessed or experienced during clinical placements. This study was guided by the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Results: The findings revealed significant educational gaps among students regarding how to manage aggressive situations, as well as high levels of concern and an aggression exposure rate exceeding 30%. A statistically significant association was also observed in relation to the academic year. Conclusions: This study provides a foundation for the development of specific training programmes tailored to the needs identified and for enhancing occupational safety in healthcare settings. Full article

Background: It is generally well-known that narration of care is critically important to high-quality nursing care. Narration of care is loosely defined as a nurse’s ability to describe to patients and families the clinical purpose behind nursing practice, what is hoped to be achieved, and the “why” (or clinical rationale) behind nursing activities. Despite the importance of narration of care, there is little practical guidance given to nurses about how to narrate care—what makes for effective or ineffective narration of care. Objective: Our aim was to develop a framework for teaching nurses and patient care assistants (PCAs) on how to effectively narrate care. In this article, we provide a practical framework for teaching nurses and PCAs how to narrate care. We describe the process of developing the framework as part of quality improvement efforts and implementing a course for eight hospitals based on the framework. Methods: Consistent with a Plan-Do-Study Act (PDSA) quality improvement approach, we developed the framework by first conducting a data and literature review, then convening a taskforce, discussing with patients on our existing committees, and finally formulating a framework. We then drafted supplementary cases and course material and implemented a course to teach nurses and PCAs how to narrate care. Results: The narration of care framework (NOC) that we developed and implemented consisted of the following five principles, which can be called RECAP as an acronym: 1. The “R” in RECAP stands for removing uncertainty. 2. The “E” in RECAP stands for explaining the environment. 3. The “C” in RECAP stands for being calm and sincere. 4. The “A” in RECAP stands for assume nothing. 5. The “P” in RECAP stands for personal connection. As for the course developed based on the RECAP principles, there was a total of 276 course offerings conducted by 30 facilitators, and 7341 nurses and PCAs completed the course. The evaluations reflected that 99% of learners believed their learning was improved by the course. Discussion: There are several multifaceted benefits to NOC: nurses’ and PCAs’ capability to narrate care well shows empathy and compassion to patients; it strengthens patient understanding and education that can lead to improved patient outcomes; and it helps allay patients’ uncertainties and anxieties. In essence, narrating care in an effective manner cultivates a strong nurse–patient therapeutic relationship. Yet, in the absence of any practical guidance, nurses and PCAs are left to develop narration skills on their own, learning by trial and error, and, in doing so, perhaps failing to meet patients’ needs and failing to fully derive the many benefits that the NOC is designed to achieve. Our hope is that, if hospital systems adopt our work, nurses and PCAs can comfortably and confidently enter the profession knowing the purpose or narrating care, its many benefits, and how to practically conduct sufficient narration, and what would constitute insufficient narration. Hospitals, in turn, can specify and clearly articulate their expectations for nurses and PCAs narrating with patients—what would make for a strong, compassionate process and what would be inadequate. For more experienced nurses, they can use the RECAP framework to reflect on their own practices and perhaps strengthen or refreshen existing skills. Conclusions: NOC is acknowledged, somewhat implicitly, as being critical to nursing and PCA practice, yet practical instruction and specified principles are lacking. We aimed to fill this gap by developing, implementing, and teaching a practical framework, armed with many tools nurses can use. Full article

Background/Objectives: This study protocol outlines the implementation of a professional development programme (ProDeveloP) designed to support newly graduated nurses (NGNs). NGNs often experience inadequacy and face challenges in developing their professional competence. Healthcare organisations can ease this transition through introduction programmes. However, effective implementation strategies in local healthcare settings remain unclear. This study aims to develop, implement, and evaluate a programme that enhances role clarity, task mastery, social acceptance, stress reduction, and recovery, contributing to increased job satisfaction and retention. Methods: ProDeveloP will be implemented at a regional hospital in mid-Sweden. This study will include a convenience sample of 110 NGNs from both the previous and the new introduction programmes, 20 dialogue facilitators involved in the programme, and 10 managers responsible for NGNs participating in the programme. Data will be collected throughout the ProDeveloP using questionnaires, individual interviews, and focus groups. The data will be analysed using both qualitative and quantitative analyses. Conclusions: This study has the potential to improve NGNs’ work-related health, job satisfaction, and retention while contributing to competence development. By offering structured reflection, mentorship, and organisational support, this research project addresses knowledge gaps in understanding the long-term impacts of introduction programmes and structured reflection, contributing to evidence-based improvements in nursing practice and healthcare leadership. Clinical trial number: NCT06742047. Registered in ClinicalTrials.gov, 19 December 2024. Full article

Surgical Site Infection (SSI) can be a devastating complication, leading to increased morbidity, mortality, and healthcare costs. Pre-surgical hand preparation is an effective strategy to prevent SSI. The two most common pre-surgical hand preparation methods are antimicrobial soap for surgical hand scrub and alcohol-based surgical hand rub. The antimicrobial soap hand scrub remains more commonly used among operating theater staff. However, several studies showed that alcohol-based hand rubs are much more effective than antiseptic soap hand scrubs. Objective: This study aimed to compare the effect of the two methods of surgical hand preparation on the number of bacterial colonies. Methods: The design of this study was a comparative study with a pre-test and post-test approach in two groups (a surgical hand scrub using 4% chlorhexidine soap group and a surgical hand rub using 70% ethyl alcohol and 2.5% chlorhexidine group). Hand smear sampling was performed before surgical hand preparation (pre-test), immediately after surgical hand preparation (post-test 1), and after the surgery was completed (post-test 2). Seventy-one hand smear samples (35 samples applied the surgical hand rub, and 36 samples applied the surgical hand scrub) were divided into two groups and examined for colony counts in Colony Forming Units (CFU) using the total plate count method. Descriptive and comparative analysis were applied. Results: The surgical hand-scrub group had average pre-test, post-test 1, and post-test 2 colony counts of 0.202 CFU/cm², 0.007 CFU/cm², and 0.016 CFU/cm², respectively, while the surgical hand-rub group had average pre-test, post-test 1, and post-test 2 colony counts of 0.163 CFU/cm², 0.001 CFU/cm², and 0.001 CFU/cm² respectively. Statistical analysis using the Friedman test showed that both methods significantly reduced the number of colonies (p < 0.01). Based on the Mann–Whitney test, there was no significant difference between the two groups regarding the number of colonies (p > 0.05). Conclusions: Surgical hand-scrub and hand-rub have similar effectiveness in reducing and maintaining the number of colonies on hands during surgery, both gram-positive and gram-negative bacteria. Full article

Background: Work engagement is essential to the well-being of nurses and the quality of health care, particularly in high-demand urban hospital environments in Bangkok. To determine the levels of work engagement—vigor, dedication, and absorption—among nurses in a Thai urban tertiary hospital, and to identify associated demographic and occupational predictors. Materials and Methods: A cross-sectional study was conducted among 650 nurses at a tertiary university hospital in Bangkok, Thailand, from February to March 2025. Participants were selected through simple random sampling. They completed an online survey including demographic data and the Utrecht Work Engagement Scale (UWES), which assesses three dimensions of engagement: vigor, dedication, and absorption. To identify the predictors of high engagement levels, chi-square tests and multivariate binary logistic regression were used. Results: Most nurses reported low engagement across all dimensions: 73.1% for vigor, 69.1% for dedication, and 70.0% for absorption. In the adjusted models, monthly income was a significant predictor of higher vigor and dedication, whereas no significant predictors emerged for absorption. Other variables, including age, experience, and professional rank, were significant in the bivariate analyses but not in the multivariate models. Conclusions: Nurse engagement remains suboptimal in the urban tertiary hospital setting, with financial compensation emerging as a key determinant. Strategic interventions to improve income equity and career development may help enhance engagement and retention in the nursing workforce. Full article

Background/Objectives: Preventive health behaviors are key to disease prevention and health system sustainability; however, population-level factors remain understudied in multilingual regions. South Tyrol, an autonomous multilingual province in Northern Italy, provides a unique setting to examine how sociodemographic and linguistic factors shape preventive behaviors. Methods: A stratified, population-representative survey of 2090 adults (aged ≥18 years) was conducted in South Tyrol in 2024. Preventive behavior was assessed using the validated 16-item Good Health Practices Scale (GHP-16). Key predictors included age, sex, education, living situation, language group, employment in the health/social sector, health literacy (HLS-EU-Q16), patient activation (PAM-10), and the mistrust of professional health information. Weighted statistics and multivariable linear regression were used to identify associations. Results: The GHP-16 scores varied significantly across sociodemographic and psychosocial strata. Female sex, older age, higher education, higher patient activation, and sufficient health literacy were independently associated with greater engagement in preventive behaviors. Patient activation showed the strongest graded effect (β = 1.739). The mistrust of health professionals was inversely associated with behavior (β = –0.050, 95% CI: –0.090 to –0.009). Italian speakers reported higher GHP-16 scores than German speakers (β = 0.377), even after adjusting for covariates. Item-level analysis revealed small but consistent differences, particularly in information-seeking and vaccination behavior. Conclusions: Preventive behaviors in South Tyrol are shaped by demographic, psychosocial, and linguistic factors. Patient activation and health literacy are key modifiable predictors, whereas language group differences suggest structural and trust-related disparities that require tailored public health strategies in multilingual settings. Full article

Background/Objectives: Quiet Quitting (QQ) describes a state of reduced workplace engagement characterized by a lack of motivation and initiative. Employees practicing QQ typically limit their efforts to fulfilling only their assigned tasks, expending the minimum necessary energy, while still ensuring the completion of their core responsibilities. QQ is an emerging phenomenon in healthcare settings following the COVID-19 pandemic and is still relatively unexplored in the literature. The aim of this study is to assess QQ among nurses in a northern Italian hospital. Methods: A cross-sectional study with a convenience sample of 91 nurses in a single-specialist orthopedic hospital was conducted. Data were collected in August 2024 using an online form of the Quiet Quitting Scale (QQS). Demographic data were collected, including gender, age, years of work experience and department. Results: A response rate of 83.50% was recorded. Data analysis revealed that 46.06% of the sample (35 nurses) was identified as quiet quitters. Fewer years of service and a younger age were associated with a higher probability of Quiet Quitting. The highest average score was observed for “Lack of motivation” subscale at 2.40 (SD = 1.14). Conclusions: The findings establish QQ as a significant issue requiring urgent attention in healthcare. To guarantee high-quality nursing care, healthcare organizations must prioritize interventions focused on enhancing employee support and work environment. Longitudinal research is necessary to explore the long-term effects of QQ on patient outcomes and to evaluate the success of targeted interventions. Full article

Background/Objectives: The under-five mortality rate (U5MR) remains a serious health challenge in Indonesia, with low birth weight (LBW) being a key risk factor. This study aimed to identify predictors of survival among under-five children with LBW using data from the 2017 Indonesia Demographic and Health Survey (IDHS). Methods: This cross-sectional study included 625 children under five with LBW. The dependent variable was under-five mortality (children aged 0–59 months), while the independent variables include child (gender), maternal (age at delivery, education, empowerment, delivery complications, and breastfeeding history), health service (antenatal care-ANC and place of delivery), and household (wealth quintile and residence) factors. Data were obtained from the 2017 IDHS using household and women’s questionnaires and analyzed using univariate analysis, Kaplan–Meier estimation, and Cox regression. Results: 41 of 625 children born with LBW died before the age of five. The Kaplan–Meier estimation found that maternal (delivery complications and breastfeeding history), health service (ANC history and place of delivery), and household factors (residence) significantly influenced the survival of LBW children. The Cox regression results showed that LBW children who were breastfeed and whose mother had adequate antenatal care visits had a lower risk of under-five mortality. Surprisingly, children born in health facilities had a significantly higher risk of death compared to those born elsewhere. Conclusions: Exclusive breastfeeding, adequate antenatal care, and place of delivery are important determinants of survival among children born with LBW. This support targeted interventions to improve the survival chances of children born with LBW, particularly in their early years of life. Full article

Background: Sexual assault affects millions globally each year, yet research on survivors’ resilience remains limited and methodologically inconsistent. Resilience after sexual assault is a multidimensional and deeply personal process shaped by psychological, social, and systemic influences. Understanding this complexity requires research methodologies that can capture both measurable patterns and lived experiences. Objectives: This integrative review explores how mixed-methods research (MMR) has been used to study resilience and healing following sexual assault. Methods: Using the framework by Whittemore and Knafl, four databases (PubMed, CINAHL, PsychInfo, and EMBASE) were searched for peer-reviewed primary research articles published between 2014 and 2024. Studies were screened and appraised independently by two reviewers using predefined inclusion and exclusion criteria and a modified Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) tool. Results: Six studies met the inclusion criteria, revealing substantial variation in how mixed-methods approaches were applied. Half of the studies cited a “completeness” rationale for integrating qualitative and quantitative strands, while others emphasized enhancement, triangulation, or discovery of new insights. Integration strategies included connecting datasets sequentially, merging findings at the interpretation stage, or building new frameworks from combined results. However, only one study used a joint display to visually represent integration, highlighting an ongoing underutilization of visual synthesis tools in trauma research. Measures of resilience and associated outcomes also varied widely across studies, underscoring the complex and multidimensional nature of resilience following sexual assault. Conclusions: This review suggests that MMR can offer a deeper, more nuanced understanding of resilience among sexual assault survivors and calls attention to the need for intentional integration strategies to maximize insight. Full article

Background: The concept of evidence-based practice (EBP) is globally relevant in current healthcare climates. However, nursing students and teachers often struggle with integrating EBP effectively into a curriculum. This has implications for the way students learn to use evidence for their nursing practice. A new undergraduate EBP module was co-designed with current nursing students and university staff throughout 2023. Underpinning the module was a UDL (universal design for learning) pedagogy consisting of flexible approaches to learning for nursing students which included co-developed videos, co-developed audio podcasts, and co-developed serious games to complement traditional flipped classroom learning. The module commenced in September 2023, running in Year 1 one of a 3-year undergraduate nursing program, and was co-taught by staff and senior students. Methods: A pre/post-test design was used to collect data on student attitude, knowledge, and utilization of EBP. A total of 430 students completed two validated questionnaires, the EBP Beliefs Scale© and EBP Implementation Scale©, before and after the module. Following the post-test, six focus group interviews were also conducted with 58 students to explore how the module informed student nursing practice whilst attending clinical placement during Year 1. A convergent mixed-methods design was employed. Sample attrition occurred (~25%). Effect sizes and 95% confidence intervals were calculated for primary outcomes. Results: Quantitative data was analyzed using paired t-tests and this highlighted statistically significant improvements in attitude, knowledge and utilization of evidence-based practice after learning (p < 0.001). Qualitative data was transcribed verbatim, thematically analyzed, and highlighted three main findings; EBP is my business, EBP positively influenced the care of my patients and EBP has positively impacted my professional development. Conclusions: Partnership with current nursing students in the co-design and implementation of a module about EBP was associated with improvements in student knowledge, attitude and utilization of evidence in practice. These factors are likely to also improve professional competence and ultimately patient care. Full article

Background/Objectives: Inequalities in access to nursing professionals represent a significant challenge to achieving equity in healthcare systems. In decentralized countries like Italy, disparities in the distribution of nurses persist despite a universal national health system. This study investigates the extent and determinants of regional inequality in the distribution of the nursing workforce in Italy. Methods: A retrospective ecological analysis was conducted using administrative data from official national sources (ISTAT, Ministry of Health) concerning the number of nurses and population per region, along with Human Development Index (HDI) data from 2021. Descriptive statistics, the Gini coefficient, Lorenz curve, and Pearson correlation were used to assess inequality and identify influencing factors. Results: The national Gini coefficient was 0.136, indicating a moderate degree of inequality in the distribution of nurses across Italian regions. A strong positive correlation was observed between HDI and nurse-to-population ratio (r = 0.76, p < 0.001), suggesting that more developed regions have higher nursing density. Conclusions: Despite a universal healthcare system, Italy shows persistent regional disparities in nurse distribution. These findings emphasize the need for targeted policies and coordinated planning to reduce inequalities and ensure equitable access to nursing care across all regions. Full article

Workplace violence is a widespread issue affecting hospital nursing staff and significantly undermines their psychological well-being. Such violence originates from various sources, including users, colleagues, and supervisors. Psychological resilience has been linked to more favourable indicators of well-being. Background/Objectives: This study aimed to explore how different sources of workplace violence (users, colleagues, and supervisors) are related to psychological well-being and psychological resilience. Additionally, it examines whether resilience is statistically associated with a mediating role in the relationship between source-specific workplace violence and the psychological well-being of hospital nurses. Methods: A cross-sectional, multicentre, descriptive, and mediational study was conducted with a sample of 447 hospital nurses. Participants completed a self-administered questionnaire assessing workplace violence from users, colleagues, and supervisors, alongside measures of resilience, psychological well-being, and sociodemographic characteristics. Results: Among all reported incidents of workplace violence in the previous year, 69.2% were attributed to users, with verbal abuse (68.7%) being more prevalent than physical aggression (24.1%). Additionally, 37% of nurses reported experiencing violence from colleagues, and 25% from supervisors. Workplace violence from all three sources was significantly associated with both psychological well-being and resilience. Resilience was statistically associated with a mediating role in the relationship between workplace violence and nurses’ psychological health, suggesting a potential mechanism of influence without implying causality. Conclusions: The prevalence of workplace violence from users, colleagues, and supervisors among hospital nurses is notably high. Findings indicate that violence from any of these sources is negatively associated with psychological well-being. However, resilience mitigates this impact by reducing psychological distress, positioning it as a crucial personal resource for nurses facing such adversity. These results underscore the need for interventions aimed at developing and strengthening resilience among hospital nursing staff. Moreover, the findings can inform the design of organisational strategies to prevent violence and to promote resilience and well-being within healthcare settings. Full article

Background: Cancer is a worldwide public health issue that impacts individuals in many ways. Family caregivers (FCGs) play a crucial role in providing care for cancer patients; as a result, they face several challenges as caregivers that sometimes go unreported. Aim: The purpose of this study was to explore the lived experiences of family caregivers with a developing burden of caring for a relative with a cancer diagnosis in Saudi Arabia. Methods: A qualitative study employing thematic analysis was conducted with ten family caregivers recruited through purposive sampling from the Prince Sultan Military City Hospital’s oncology department. Semi-structured interviews were conducted from July to August 2023 until data saturation was achieved. Results: Ten family caregivers participated in the study. Four main themes emerged from the data: antecedents to the caregiving burden, attributes of the caregiving burden, consequences of the burden, and religion and beliefs. Across these four main themes, there were 12 sub-themes. Conclusions and Implications: Family caregivers are crucial in caring for and supporting cancer patients. Thus, it is essential to shed light on family caregivers, who often remain invisible as secondary patients in healthcare systems, to understand the factors associated with developing caregiver burden. Education and support for family caregivers may decrease the burden on the family caregiver, which can positively impact the whole family unit, including the relative with the cancer diagnosis. Full article

Background: Nurses play a crucial role in health promotion (HP) policy and in encouraging healthy behaviors. However, challenges persist in effectively integrating HP as a core component of healthcare systems and nursing practice. Therefore, it is essential to develop specialized and advanced competencies in nursing students, incorporate HP into nursing academic curricula, and better understand the factors influencing nursing students’ development of these competencies—an area that remains underexplored. Accordingly, this study explores and describes the factors nursing students perceive as essential in developing competencies in HP and in fulfilling their role as health promoters. Methods: A qualitative study was conducted using Reflexive Thematic Analysis. Data were collected through semi-structured interviews with 19 nursing students. Results: Five main themes emerged: (1) Training Needs of Future Health Promoters, (2) Navigating Time Constraints in Health Promotion, (3) Nurses’ Awareness of Their Role in HP, (4) Perceived Need to Adopt Healthier Lifestyles, and (5) Challenges of Lifestyle Management. Key facilitators included strong mentorship and well-structured educational programs; barriers included insufficient clinical exposure and time constraints. Additionally, students emphasized the need for HP to be a core aspect of nursing curricula. While acknowledging existing obstacles, participants also identified practical solutions that could be integrated into training and practice to enhance the impact of HP in nursing care. Conclusions: The study highlights significant gaps in HP education for nursing students and the need for curriculum reforms to better prepare them as health promoters. Future research should consider the perspectives of clinical mentors and evaluate the effectiveness of innovative teaching methods—such as simulation-based training—in strengthening students’ HP competencies. Full article

Background: Symptoms of and treatments for inflammatory bowel disease have an impact on patients’ health-related quality of life and result in a need for self-care strategies. Little is known about factors affecting long-term outcomes and the types of coping strategies used by adult patients with inflammatory bowel disease to better cope with their chronic illness. Objective: This study aims to explore coping strategies, social support, and health-related quality of life and describe factors affecting long-term outcomes for patients with inflammatory bowel disease. Methods: A cross-sectional design was used, with a consecutive sample of 206 patients with inflammatory bowel disease who were recruited at three gastroenterology clinics in Sweden and given surveys consisting of patient characteristics, the Brief COPE, and a social support questionnaire. Descriptive statistics were used to analyze the data. This study was guided by Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Results: The sample was 53% women and included 206 patients with a median age of 48 years. The coping mechanisms often used were active coping methods (problem-focused). Most of the patients had someone special by whom they felt supported (89%). Gender differences were shown for emotional support and whether the patients had someone they felt close to. According to the findings, less bowel interfering and social support correlated with higher well-being. Worry was associated with giving up, symptom burden, and less bowel interfering. No significant correlations were shown for symptom burden and social support. Conclusions: Social support, especially from someone at home or offering comfort, was positively linked to well-being. Active, problem-focused coping was common and associated with better outcomes. Notably, no direct link was found between symptom burden and coping or support, underscoring the complexity of these relationships. These findings emphasize the need for psychosocial interventions to enhance coping and support, ultimately improving health-related quality of life in IBD. Full article

Background/Objectives: Self-care in people with diabetes requires constant physical and emotional effort, which can be a barrier to adhering to the care plan. The sense of coherence (SOC) might play a role in self-care. This study aimed to examine the relationship between sense of coherence and self-care in people with Diabetes Mellitus. Methods: A systematic review with narrative synthesis (14 studies) and with meta-analysis (seven studies) was conducted. We searched PubMed, CINAHL, PsychInfo and Scopus up to June 2025. We included original studies that assessed the relationship between SOC and self-management in people with diabetes and reported the correlation coefficient or other compatible statistic. Selection bias (probabilistic vs. non-probabilistic), classification bias (validity and reliability of the instrument) and confounding (control of sex, age and type of diabetes) were evaluated. The meta-analysis used a random-effects model with sensitivity and subgroup analyses to assess robustness. Results: Fourteen studies with 9800 participants (type 1 or 2 diabetes) were included. Of the studies, eight used probability sampling, only one had classification bias risk, and three had low bias risk. A positive, moderate association was found between SOC and adherence to self-care (r = 0.32; 95% confidence interval (CI): 0.29, 0.35; N = 3985; average per study: 569.3). Limitations: a small number of studies; all were descriptive and cross-sectional. Conclusions: A sense of coherence may play a relevant role in improving adherence to the self-care plan in people with type 1 or 2 diabetes. Full article

Background/Objectives: Missed outpatient appointments contribute to care discontinuity and emergency department (ED) overcrowding. This study investigated the association between missed appointments and ED visits, identifying predictors such as patient characteristics, distance from the hospital, and waiting time. Methods: A retrospective analysis was conducted using a dataset of 749,450 scheduled outpatient appointments from adult patients (aged ≥ 18 years). Patients under 18 were excluded. We identified missed appointments and assessed their association with ED visits occurring in the same period. Descriptive statistics, non-parametric tests, and logistic and linear regression models were applied to examine predictors such as age, sex, distance from the hospital, waiting time, the type of service, and medical specialty. Results: The overall no-show rate was 3.85%. Among patients with missed appointments, 37.3% also visited the ED. An older age (OR = 1.007; p = 0.006) and the male gender (OR = 1.498; p < 0.001) were significant predictors of having a scheduled appointment before an ED visit. No significant associations were found for distance or specialty branch. Conclusions: Missed appointments are associated with ED utilization. Predictive factors can inform targeted interventions, such as via improved scheduling systems and personalized reminders. Distance alone may not be a barrier, but system-level solutions are needed to address no-show rates and optimize healthcare resource use. Full article

Introduction: Few applications worldwide focus on psychosocial rehabilitation, and none specifically address psychosocial rehabilitation projects. This justifies the need for an application to assist mental health professionals in constructing and managing such projects in the Brazilian mental health scenario. Objective: This study aimed to present a web application, the “Psychosocial Rehabilitation Application” (Psychosocial Rehab App), and describe its development in detail through a technological survey conducted between May 2024 and February 2025. Method: The development process of the web app was carried out in the following four stages, adapted from the Novak method: theoretical basis, requirements survey, prototyping, and development with alpha testing. The active and collaborative participation of the main researcher (a psychiatric nurse) and two undergraduate software engineers, supervised by a software engineer and a professor of nursing and psychology, was essential for producing a suitable operational product available to mental health professionals. Interactions were conducted via video calls, WhatsApp, and email. These interactions were transcribed using the Transkriptor software and inserted into the ATLAS.ti software for thematic analysis. Results: The web app “Psychosocial Rehabilitation Application” displays a home screen for registration and other screens structured into the stages of the psychosocial rehabilitation project (assessment, diagnosis, goals, intervention, agreements, and re-assessment). It also has a home screen, a resource screen, and a function screen with options to add a new project, search for a project, or search for mental health support services. These features facilitate the operation and streamline psychosocial rehabilitation projects by mental health professionals. Thematic analysis revealed three themes and seven codes describing the entire development process and interactions among participants in collaborative, interrelational work. A collaborative approach between researchers and developers was essential for translating the complexity of the psychosocial rehabilitation project into practical and usable functionalities for future users, who will be mental health professionals. Discussion: The Psychosocial Rehab App was developed collaboratively by mental health professionals and developers. It supports the creation of structured rehabilitation projects, improving decision-making and documentation. Designed for clinical use, the app promotes autonomy and recovery by aligning technology with psychosocial rehabilitation theory and the actual needs of mental health services. Conclusions: The Psychosocial Rehab App was developed through collaborative work between mental health and technology professionals. The lead researcher mediated this process to ensure that the app’s functionalities reflected both technical feasibility and therapeutic goals. Empathy and dialog were key to translating complex clinical needs into usable and context-appropriate technological solutions. Full article

Background: Chronic diseases negatively impact health outcomes and are attributed to elevated morbidity and mortality throughout the world. Rural populations are disproportionately affected by chronic diseases and have limited access to health programs and resources. The purpose of this qualitative study was to explore the cognitive impact that a web-based lifestyle medicine intervention had on participants recruited from rural community settings in the southeastern United States. This qualitative study was the second phase of a mixed methods design, which used a randomized controlled trial to evaluate intervention effects. Methods: The descriptive design of this qualitative study included semi-structured interviews to collect information about the impact of a lifestyle medicine intervention. The interviews were transcribed verbatim and analyzed using the grounded theory method of thematic analysis in an iterative process for discovering patterns, central themes, and concepts. Results: The four themes that emerged were (a) gaining awareness and overcoming barriers, (b) encouraging others as a “ripple effect”, (c) realizing actualities, and (d) seeing progress. These themes highlighted the cognitive impact of an online lifestyle medicine program and provided insights about how rural dwellers perceived and processed educational health information. Conclusions: This study shows that the intervention had a positive influence on participants that continued after participation. The findings of this study provide recommendations that can facilitate intervention development and implementation among rural populations. Full article