Nursing Reports doi: 10.3390/nursrep16110401

Authors: Khadija Matrook Muna Alasfoor Ebrahim Rajab

Background/Objectives: Physical activity is an important component of type 2 diabetes (T2DM) management, and nurses are well-positioned to promote it in routine care. However, little is known about its implementation by diabetes nurses working in primary healthcare in Bahrain. This study examined nurses’ perceptions, confidence, recognition of physical activity recommendations, awareness and use of guidelines, promotion practices, and perceived barriers to physical activity. Methods: A national cross-sectional study, using a census approach, was conducted to invite all 52 eligible designated Central Diabetes Clinic Nurses and their backups across Bahrain’s 26 primary healthcare centres. All 52 eligible nurses were invited to participate, with 49 completing an online questionnaire, giving a response rate of 94.2%. Quantitative data were analysed using descriptive and exploratory statistics, and free-text responses using inductive thematic analysis. Results: Nurses strongly perceived physical activity promotion to be part of their professional role and reported high confidence in providing advice. However, 44.9% were aware of at least one physical activity guideline and 24.5% reported both awareness and use. Only 34.7% reported always assessing patients’ physical activity irrespective of presenting health needs. Nurses reported that the most commonly perceived barriers among people in Bahrain were lack of time (83.7%) and lack of motivation and support from family and friends (67.3%). Qualitative findings identified four themes: public awareness and health education; access to physical activity facilities and opportunities; motivation and behavioural support; and healthcare and community support. Conclusions: Participating nurses reported strong professional commitment to physical activity promotion, but their reported practices were less consistently informed by guidelines and routine physical activity assessment. Greater awareness and implementation of existing guidance, practical approaches to physical activity assessment, clearer referral pathways, and coordinated healthcare and community support may strengthen physical activity promotion.

Nursing Reports doi: 10.3390/nursrep16110400

Authors: Gabriel Augusto Cordeiro dos Santos Chennyfer Dobbins Abi Rached Ingrid Magali de Souza Pimentel Debora Rodrigues Vaz Renata Camargo Alves Alfredo Almeida Pina de Oliveira Rodrigo Jensen

Background/Objectives: Digital communication systems may streamline hospital requests without eliminating nurses’ responsibility for coordinating responses. Little is known about how nurses’ experience of successive workplace technologies informs their assessment of this redistribution of work. This study explored how Brazilian female nurses over 40 perceived a digital interaction tool, without assuming effects specific to age or gender. Methods: We conducted a secondary qualitative analysis of 10 interviews with female nurses aged 41–55, selected from 20 interviews conducted at a hospital in São Paulo, Brazil. Following Braun and Clarke’s reflexive thematic analysis, we examined accounts of technological learning, request management, interdepartmental coordination and patient contact. The original interviews were not designed to investigate age- or gender-specific mechanisms. Results: Four themes were developed: (1) learning again without starting from scratch; (2) no longer the go-between for every request; (3) when a digital request still needs a phone call; and (4) making work visible without losing personal contact. Participants described easier request initiation and greater team autonomy, alongside learning demands, duplicated communication and unresolved requests. Across themes, digital delegation of request entry did not necessarily transfer responsibility for follow-up and resolution. Conclusions: Participants appraised the technology in relation to existing work practices and continued professional accountability. Its perceived benefits depended on usable interfaces, ongoing support and timely interdepartmental responses. This analysis offers a context-specific account of the distinction between digitizing requests and redistributing coordination responsibilities; it does not demonstrate reduced workload, improved patient outcomes or age- or gender-specific effects.

Nursing Reports doi: 10.3390/nursrep16110399

Authors: Marina R. Ramírez Mercy P. Ontaneda

Background/Objectives: Burnout is a multidimensional occupational-health concern in nursing, yet post-pandemic evidence from Ecuador remains limited. This exploratory study aimed to identify sociodemographic and work-related characteristics independently associated with emotional exhaustion, depersonalization, and personal accomplishment among nursing professionals, using separate adjusted models. Methods: This cross-sectional study analyzed primary data from 462 nursing professionals participating in a national Ecuadorian research project. Burnout was assessed with the Maslach Burnout Inventory–Human Services Survey (MBI-HSS). Separate multivariable ordinary least-squares models with HC3 robust standard errors were fitted for each dimension, with Benjamini–Hochberg false discovery rate (FDR) correction across 24 non-intercept coefficients. Results: Mean scores were 17.09 (SD = 11.28) for emotional exhaustion, 6.61 (SD = 6.06) for depersonalization, and 30.99 (SD = 11.61) for personal accomplishment; using historical descriptive thresholds, 19.0% scored in the high emotional-exhaustion range, 32.2% in the high depersonalization range, and 52.7% in the low personal-accomplishment range. Older age was associated with lower emotional exhaustion (B = −0.211; 95% CI, −0.347 to −0.074; padj = 0.012), lower depersonalization (B = −0.122; 95% CI, −0.191 to −0.054; padj = 0.005), and higher personal accomplishment (B = 0.238; 95% CI, 0.098 to 0.377; padj = 0.005). Male sex was associated with higher depersonalization (B = 3.068; 95% CI, 1.499 to 4.637; padj = 0.003). Moderate (B = 4.134; padj = 0.014) and little/none (B = 6.958; padj = 0.005) institutional resource availability were associated with higher emotional exhaustion compared with full availability. Conclusions: Older age was associated with lower emotional exhaustion and depersonalization and higher personal accomplishment; male sex was associated with higher depersonalization, and lower perceived institutional resource availability with higher emotional exhaustion. These cross-sectional associations do not establish causation. Longitudinal research directly measuring organizational demands and resources is warranted.

Nursing Reports doi: 10.3390/nursrep16110398

Authors: Luís Furtado Fábio Coelho Cândida Ferrito

Background/Objectives: Evidence-based practice (EBP) is a core competency in undergraduate nursing education, yet how it is taught remains poorly mapped. This scoping review aimed to synthesise the evidence on curricular integration, pedagogy, learning resources, assessment, and outcomes of EBP teaching in undergraduate nursing programmes. Methods: This review followed JBI methodology and PRISMA-ScR reporting guidelines; the protocol was registered on the Open Science Framework (No. d3jsq). Eligible sources addressed undergraduate nursing students in higher education, regardless of study design, language, or publication date. PubMed, MEDLINE, CINAHL, Scopus, and Web of Science were searched on 1 March 2026, complemented by grey literature and reference-list screening; extraction was conducted independently by two reviewers and complemented by the AI tool Elicit. Methodological quality was appraised using JBI checklists without influencing study selection, and findings were synthesised narratively into five thematic axes. Results: Fifty-five sources (47 primary sources and 8 evidence syntheses), mostly published from 2015 onwards and originating chiefly from North America and Europe, met the inclusion criteria. EBP was most often delivered as a standalone course or embedded within research-methods or clinical-placement courses, with the reported teaching most often delivered late in the curriculum and rarely underpinned by a theoretical framework. Active strategies were widely reported but generally supplemented, rather than replaced, didactic teaching, with learning resources centred on bibliographic databases, followed by librarian support and digital tools. Assessment and outcomes relied predominantly on validated self-report instruments, with performance-based measures used considerably less often. Of the 34 appraised studies, most were rated low–moderate to moderate in quality, and heavy reliance on self-report measures together with a North American/European concentration of sources limits the certainty and generalisability of these findings. Conclusions: The mapped evidence suggests that EBP teaching has diversified without a matching theoretical grounding or assessment capable of verifying its translation into practice, pointing to the potential value of progressive curricular sequencing, explicit alignment between pedagogical choices and competencies, and assessment capturing demonstrated rather than self-reported reasoning. This review received no external funding.

Nursing Reports doi: 10.3390/nursrep16110397

Authors: Miyuki Takase Naomi Kisanuki Yoko Sato Masako Yamamoto

Background/Objectives: Despite recommendations that all hospitalized older adults receive tailored fall-prevention education, studies suggest that many patients at risk of falling do not receive such education. Furthermore, some patients may not recognize having received fall-prevention instructions, potentially limiting their effectiveness. This study examined the proportion of older patients who reported recognizing that they had received fall-prevention instructions from nurses and the characteristics associated with this recognition. Methods: A nationwide online survey was conducted among Japanese adults aged ≥60 years who were currently hospitalized or had been discharged within the previous year. Fall-risk recognition and recognition of fall-prevention instructions received from nurses were assessed by self-report. Latent class analysis identified two fall-risk profile groups, and logistic regression was used to examine factors associated with reported receipt of these instructions. Results: Among 3608 participants, more than 40% reported that they had not recognized receiving fall-prevention instructions. After excluding 395 participants without identified fall-risk factors, fall-risk profile and age were associated with self-reported recognition. Participants with mobility impairment and other risk factors more frequently reported recognizing receipt of instructions than those with other risk factors but no mobility impairment. Conclusions: Whether participants’ reports reflect a lack of instruction provision or poor recall remains unclear. Failure to recognize or receive fall-prevention instructions may limit patients’ ability to implement preventive behaviors. Enhancing nurses’ awareness of fall-risk profiles and providing consistent patient education may improve recognition of fall-prevention instructions and support fall prevention in hospital settings.

Nursing Reports doi: 10.3390/nursrep16110396

Authors: Alba Maestro-Gonzalez Marta Sánchez-Zaballos Maria-Pilar Mosteiro-Diaz David Zuazua-Rico

Background: Empathy is widely recognised as a core professional value in nursing, underpinning high-quality, person-centred care and therapeutic relationships in a profession characterised by sustained interaction with patients and families. However, few studies have followed the same nursing students throughout their entire undergraduate programme. Objectives: To examine longitudinal changes in clinical empathy and its dimensions among Spanish nursing students throughout the four-year undergraduate nursing degree and to explore associations between empathy scores and selected sociodemographic characteristics. Methods: A prospective longitudinal cohort study included four annual assessments (2020–2023) at a Spanish public university. Clinical empathy was measured with the Jefferson Scale of Empathy–Health Professions Students (JSE-HPS). Spearman rank correlations assessed score stability; adjusted linear mixed-effects models evaluated changes over time and sociodemographic associations, followed by Tukey-adjusted comparisons. Results: Of 150 eligible students, 126 participated at baseline (84.0%). The mean total score fell from 117.37 at the first assessment to 87.75 at the second and remained relatively stable thereafter. Assessment time was significantly associated with the total score and all three dimensions (all p ≤ 0.003). Total, Compassionate Care, and Standing in the Patient’s Shoes scores were higher at the first than at all subsequent assessments; Perspective Taking differed only between the second and fourth assessments. Age was positively associated only with Compassionate Care (β = 0.15; p = 0.039), but this finding should be considered exploratory given the number of outcomes examined; other covariates showed no associations. Conclusions: Self-reported empathic orientation declined mainly between the first and second academic years and changed little thereafter, although the dimensions followed distinct trajectories. These findings support monitoring empathy and suggest attention to educational support early in nursing education.

Nursing Reports doi: 10.3390/nursrep16110395

Authors: Diego Serrano-Gómez Silvia Aranda-Moreno María Consuelo Sáiz-Manzanares Celia Carrillo

Background: During the COVID-19 pandemic, synchronous hybrid teaching was implemented in the Nursing Degree at the University of Burgos to enable simultaneous face-to-face (F2F) and online attendance. Although this teaching model has remained of interest beyond the pandemic, evidence comparing educational outcomes according to attendance modality remains limited in nursing education. Objective: To compare educational outcomes, satisfaction levels, and student perceptions associated with F2F and online attendance within a synchronous hybrid teaching model. Methods: An observational, cross-sectional, comparative study was conducted among second-year nursing students enrolled in three theoretical courses (Pharmacology, Research Methodology and Information Systems, and Nutrition and Diet Therapy) during the 2020–2021 and 2021–2022 academic years at the University of Burgos (Spain). Data were collected through knowledge assessments, satisfaction questionnaires, and open-ended survey responses. Comparisons between attendance modalities were performed using parametric and non-parametric tests as appropriate. Mean differences and 95% confidence intervals (95% CI) were reported. p-values were adjusted for multiple comparisons using the Benjamini–Hochberg false discovery rate (FDR) procedure. Results: The association between attendance modality and educational outcomes varied across study units and assessment methods. At class level, the largest differences were observed in Nutrition and Diet Therapy, where F2F students obtained higher knowledge scores than online students (mean differences ranging from 2.41; 95% CI 0.34–4.47 to 3.71; 95% CI 2.13–5.30 points). In end-of-course assessments, mean knowledge scores were higher among predominantly F2F students in all study units and academic years, although none of these differences remained statistically significant after FDR adjustment. Satisfaction results also varied according to study unit, although attention was consistently rated more favorably in F2F classes across all end-of-year evaluations, a finding that remained significant after FDR adjustment. Qualitative findings showed that students associated F2F attendance with greater attention, understanding, and interaction, whereas flexibility, comfort, and organizational advantages were the main reasons for preferring online attendance. Conclusions: Associations between attendance modality, knowledge assessment scores, and student satisfaction varied according to study units and assessment method. In several analyses, students attending F2F classes reported more favourable learning experiences and obtained higher scores than students attending online classes. However, given the observational nature of the study, these differences should be interpreted cautiously. The findings suggest that attention, interaction, and student engagement deserve particular consideration when implementing synchronous hybrid teaching in undergraduate nursing education.

Nursing Reports doi: 10.3390/nursrep16110394

Authors: Mohammad Yahya Ayoub Halim Mad Lazim Hendrik bin Lamsali

Background/Objectives: Nurses’ capacity to enact Lean-oriented hospital improvement is often conflated with organizational support. This review examines capability, context, implementation, sustainment, and outcomes. Methods: Targeted, non-exhaustive searches in PubMed and Scopus, supplemented by Google Scholar and citation chaining, were updated on 30 July 2026. Sixty empirical reports published during 2007–2026 were synthesized using interpretive comparison and claim-level appraisal, without quantitative pooling. Results: Three psychometric reports concerned two nursing-specific Lean instruments; no identified instrument directly validated the specific capability construct proposed here. We interpret practical knowledge and judgement, collective problem-solving, learning, professional agency, and enacted leadership as candidate manifestations requiring validation. Operational process changes were reported, but causal attribution was weak. Evidence for reallocated bedside time, net economic value, workforce or patient benefit, environmental benefit, and long-term sustainment was limited or inconsistent. Conclusions: The framework is a provisional interpretive map. Future evaluations should measure capability, context, implementation, sustainment, benefits, and harms separately.

Nursing Reports doi: 10.3390/nursrep16110392

Authors: Florbela Bia Matheus Kirton dos dos Anjos Zaida Charepe Cristina Marques-Vieira

Background/Objectives: Policies for residential long-term care seek to safeguard quality, dignity and residents’ rights, yet their translation into practice remains uneven. This review synthesised textual evidence on policies, guidelines and regulatory frameworks for long-term care facilities in European countries with public or universal health systems. Methods: A Joanna Briggs Institute systematic review of textual evidence was conducted (PROSPERO CRD420251132804). CINAHL, MEDLINE, ProQuest Dissertations and Theses, MedNar and Google Scholar were searched (March–May 2025; updated May 2026), with citation searching and targeted searches of EU and OECD repositories. Two reviewers independently screened, appraised and extracted data; findings were integrated through thematic synthesis. Results: Of 2468 records identified, 35 sources (1993–2026) were included: three policy or guidance texts and 32 empirical, review or policy-analysis publications (eight policy analyses or conceptual papers, 20 primary studies and four reviews). Five themes were developed: governance and regulation; guideline implementation; workforce and organisational dynamics; rights, autonomy and ethics; and anticipated pressures and emerging care models. Staffing instability, limited training, fragmented governance and organisational constraints affected implementation. Conclusions: Participatory governance, workforce investment, relational implementation strategies and human rights principles emerge as priorities, with nursing leadership central to translating policy into care. Source heterogeneity and the interpretative synthesis limit generalisability.

Nursing Reports doi: 10.3390/nursrep16110393

Authors: Biagio Nicolosi Marina Maffeo Giuseppina Di Maro Felice Curcio Giovanni Becattini Alessio Petronici Gianluca Azzellino Emanuele Buccione Greta Ghizzardi Rosario Caruso

Background/Objectives: We compared recorded pre-hospital first-aid categories by citizenship among children hospitalized for burns, accounting for a classification rule that may obscure the use of multiple first-aid actions. Methods: This exploratory descriptive analysis included 369 children aged 0–17 years, each contributing one index hospitalization at Meyer Children’s Hospital, Florence, Italy (January 2020–April 2026). Free-text histories had been classified as running-water cooling, explicit no first aid, or a remedy labeled inappropriate. When cooling and a remedy were both documented, the record was assigned to the remedy category. We estimated absolute differences, fitted multinomial logistic models, and calculated bounds for receipt of any cooling. Results: Recorded citizenship was Italian for 253 children and non-Italian for 116. The cooling, no-first-aid, and remedy categories accounted for 79.1%, 12.3%, and 8.7% of Italian records and 61.2%, 19.0%, and 19.8% of non-Italian records, respectively (global p = 0.0009). The difference in the cooling category was −17.8 percentage points (95% CI −28.0 to −7.9). After adjustment for age, admission year, and residence, multinomial odds ratios for non-Italian versus Italian citizenship were 2.04 (95% CI 1.07–3.91) for no first aid and 3.15 (1.56–6.35) for remedies, each relative to cooling. Because cooling status within remedy records was unknown, the difference in receipt of any cooling could range from −26.5 to +2.0 percentage points. Conclusions: Recorded categories differed by citizenship in this hospital cohort, but did not establish the direction of a difference in receipt of any cooling or a difference in guideline adherence. Separate recording of first-aid actions is needed before interpreting this association as a gap in care.

Nursing Reports doi: 10.3390/nursrep16110391

Authors: Yasmin Khamis-Ali Cristo-Manuel Marrero-González Aythamy González-Darias Irene González-Pérez

Background/Objectives: Non-invasive telemonitoring may support heart-failure management, but the nursing activities embedded within complex programmes are not always clearly distinguished from technological and multidisciplinary components. This systematised review synthesised contemporary evidence on clinical outcomes, self-care, health education, nursing roles and continuity of care. Methods: We searched PubMed, CINAHL, Scopus, SciELO, Dialnet and LILACS for original studies published between January 2020 and June 2026 in English, Spanish or Portuguese. Findings were synthesised narratively and appraised descriptively using Joanna Briggs Institute tools. Independent duplicate screening, extraction and appraisal were not undertaken. Results: From 232 identified records, 23 publications representing 21 independent studies or parent trial populations were included. Evidence was heterogeneous: some structured programmes reported fewer heart-failure-related hospitalisations or worsening events, while others showed neutral or inconsistent clinical effects. Nursing activities included symptom assessment, alert interpretation, health education, self-care support, structured communication and care coordination. Their independent effects could not be isolated from broader multidisciplinary interventions. Conclusions: Non-invasive telemonitoring may support selected patients when integrated into responsive clinical pathways, but its effectiveness should not be generalised across settings. This review clarifies the nursing care processes involved rather than establishing a pooled effect of telemonitoring. The review was retrospectively registered with the Open Science Framework (https://osf.io/r42cm/ (accessed on 18 October 2026)).

Nursing Reports doi: 10.3390/nursrep16110390

Authors: Lisa Skär Malin Holmström-Rising Anton Borg Martin Boldt Siv Söderberg

Background/Objectives: The integration of Artificial Intelligence (AI) and Machine Learning (ML) in healthcare has shown promise for analyzing complex data and identifying patterns that can enhance clinical decision-making and patient care. Patient complaints represent a valuable yet underutilized data source for improving healthcare quality and patient safety. This study aimed to investigate whether an AI-driven model could effectively categorize patient complaints and extract actionable insights to support person-centered care and quality improvement in nursing practice. Method: A total of 368 retrospective patient complaint reports collected by a Patients’ Advisory Committee were analyzed using AI-driven clustering and classification techniques. The complaints were pre-processed through text cleaning, tokenization, and vectorization before being analyzed with both an unsupervised clustering algorithm and a supervised classification algorithm. Results: The AI-based classification demonstrated that complaint texts could be classified according to four existing PAC categories (based on 290 complaint reports): (1) Care and Treatment, (2) Communication, (3) Administrative Management, and (4) Availability. These areas encompassed themes such as diagnostic delays, poor communication, fragmented administrative processes, and limited accessibility. The results highlighted that communication failures, insufficient empathy, and lack of continuity were central to patient dissatisfaction. The results indicate that automated analysis can support the systematic identification of recurring issues and patterns in patient complaint reports. Conclusions: This pilot study suggests that an AI-driven model may support the systematic classification and exploration of patient complaint reports. The supervised classification model demonstrated moderate performance in approximating four pre-existing PAC categories, including that the complaint texts contained information relevant to predicting these categories. However, the findings should be interpreted cautiously, as the model was evaluated against existing PAC classifications rather than an independent gold standard. The study did not assess workload, processing time, or cost, and therefore no conclusions can be drawn regarding efficiency gains. However, larger datasets, independent expert validation, and careful consideration of ethical, legal, and governance requirements are needed before the model can be implemented more broadly.

Nursing Reports doi: 10.3390/nursrep16110389

Authors: Inmaculada Ocaña Mérida Juan Manuel Cánovas Pallarés Teresa Sánchez-Moya Guillermo Doménech-Asensi

Background/Objectives: Debriefing is a key component of clinical simulation that promotes reflective practice and experiential learning, with demonstrated benefits for patient safety and professional performance. However, its structured implementation in out-of-hospital emergency services remains limited and insufficiently standardized. This study aimed to explore the level of knowledge, training exposure, perceived usefulness, and implementation of debriefing among healthcare professionals in a prehospital emergency service. Methods: A descriptive, observational, cross-sectional study was conducted among physicians, nurses, and emergency medical technicians (EMTs) working in the 061-emergency service of the Murcian Health System (Spain). An anonymous and self-administered questionnaire was distributed (n = 1278), including sociodemographic variables, simulation training exposure, knowledge and perceived usefulness of debriefing. The validated Spanish version of the DASH instrument and a Spanish-translated version of the OSAD instrument was used for exploratory assessment purposes. Results: A total of 49 professionals participated (response rate: 3.8%). Overall, 85.7% of participants were familiar with debriefing, and 65.3% rated it as highly useful. However, 55.1% reported no simulation-based training within the service in the previous year. A statistically significant association was found between professional category and perceived usefulness of debriefing (p < 0.001), with EMTs reporting lower perceived usefulness compared to physicians and nurses. Despite this, when debriefing was conducted, it was generally rated as high-quality, particularly in terms of psychological safety and reflective engagement. The lowest scores were observed in the domain of application to clinical practice. Key barriers included lack of time (72%), insufficient trained facilitators (60%), and limited educational resources (50%). Conclusions: A substantial gap exists between theoretical awareness and the practical implementation of structured debriefing in prehospital emergency settings. While debriefing is positively perceived and effectively delivered when applied, organisational barriers and profession-specific differences hinder its routine use. Targeted strategies, including facilitator training, dedicated resources, and tailored approaches for different professional groups, are needed to enhance its integration into clinical practice.

Nursing Reports doi: 10.3390/nursrep16110388

Authors: Richard Gray Martin Jones Jacqueline Sin Irene Ngune Daniel Bressington

Family intervention for schizophrenia is one of the clearest examples of the evidence-to-practice gap in mental health care [...]

Nursing Reports doi: 10.3390/nursrep16110387

Authors: Carla Isabel González-Páez Socorro Arnedillo-Sánchez Rubén Morilla-Romero-de-la-Osa

Background/Objectives: Gestational weight gain (GWG) outside recommended ranges remains common. Although body image, sociocultural appearance-related influences, and social media may shape maternal health behaviors, their independent associations with objectively measured GWG remain insufficiently understood. This study investigated the independent associations of clinical characteristics, body image, sociocultural appearance-related influences, and Instagram use with guideline-discordant GWG. Methods: A cross-sectional study was conducted. GWG was classified according to Institute of Medicine (IOM) recommendations using objectively recorded maternal weights. Body image and sociocultural appearance-related influences were assessed using validated instruments, and Instagram use was assessed across pregnancy. Multivariable analyses were performed. Results: Of 370 recruited women, 298 were included in the final analysis. Younger maternal age and higher pre-pregnancy body mass index (ppBMI) were independently associated with excessive GWG, whereas greater peer-related sociocultural pressure was associated with lower odds of inadequate GWG. Body image dimensions were not independently associated with GWG after adjustment. In secondary trimester-specific analyses, lower Instagram use was consistently associated with higher odds of inadequate GWG across all trimesters, whereas excessive GWG was observed only among women reporting moderate Instagram use. Conclusions: Clinical and psychosocial factors were independently associated with guideline-discordant GWG in the primary models. Associations with Instagram use were identified only in secondary exploratory analyses and require confirmation in prospective studies.

Nursing Reports doi: 10.3390/nursrep16110386

Authors: Tyane Mayara Ferreira De Oliveira Liriane Maria Gonçalves Lira Natália Emanuela Da Silva Santos Lívia Maria Ribeiro Oliveira Eduardo De Lacerda Aguiar Manuel Pardo Rios Joselany Afio Caetano Francisco Gilberto Fernandes Pereira

Background/Objectives: Surgical procedures carry significant, preventable risks, rendering effective team training in safety protocols essential. Although the World Health Organization Surgical Safety Checklist reduces perioperative failures, traditional instruction often lacks immersive, experiential practice. To address this gap, this study aimed to develop and evaluate a virtual reality scenario for teaching the Surgical Safety Checklist. Methods: This is a technological development study conducted in 2025, comprising software development and expert-based evaluation of its pedagogical, user experience, and interface dimensions by seven nursing experts. Selected SQUIRE-EDU elements were used only as a complementary reference. Results: The virtual environment presents an immersive and interactive scenario covering the three phases of the surgical experience. Regarding evaluation, the experts evaluated the technology positively, with an average score of 76.7 out of a maximum of 80 points (95.9% of the maximum total score; version evaluated before the experts’ suggestions were implemented), classifying the software as “Very good” in terms of pedagogical dimensions, user experience, and interface. They also highlighted the ease of navigation, clarity of information, and potential to stimulate learning. Conclusions: The virtual reality scenario was developed and received favorable evaluations from experts regarding pedagogical aspects, user experience, and interface. The findings provide initial evidence of the scenario’s suitability for teaching the Surgical Safety Checklist. Research with nursing students and healthcare professionals is needed to assess usability, acceptability, and effects on learning outcomes.

Nursing Reports doi: 10.3390/nursrep16110385

Authors: Krishan Soriano Feni Betriana Allan Paulo Blaquera Kaori Kato Gil Soriano Hirokazu Ito Tetsuya Tanioka

Background/Objectives: Nurses increasingly deliver care through medical technology, and patients’ views of whether this care remains caring need to be measured. Existing instruments based on Locsin’s theory of Technological Competency as Caring in Nursing (TCCN) are completed by nurses or other healthcare providers. This study examined the structural validity and internal consistency of the Patient’s Perspective of Technological Competency as Caring in Nursing Scale (PP-TCCNS), a 42-item instrument developed in a previous modified Delphi study. Methods: In this cross-sectional study, reported according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN), 513 adult inpatients in 13 hospitals in the Philippines completed a web-based survey. Confirmatory factor analysis was used to refine the hypothesized six-factor model and compare it with alternative models. Robust and ordinal estimation, split-sample validation, and measurement invariance by sex and age were also examined. Results: The 42-item model fitted acceptably but showed local strain. Removing 15 redundant items produced a 27-item six-factor model with good fit (comparative fit index = 0.970; root mean square error of approximation = 0.059). This model fitted slightly better than the alternative models and was invariant across sex; invariance across age groups should be interpreted with caution because the latent covariance matrix in the older group was not positive definite. However, the factors were highly correlated (0.87–0.98), and discriminant validity was not supported. A dominant general factor explained most of the common variance (omega hierarchical = 0.975; explained common variance = 0.925), and the subscales carried little unique reliable variance. Total-score reliability was high (Cronbach’s α = 0.987). Older participants rated their care slightly more positively. Ceiling effects were marked (26.3% of participants obtained the maximum total score), and 30% of respondents gave identical answers to all items; excluding them did not change the conclusions. Conclusions: The 27-item PP-TCCNS showed preliminary evidence of structural validity and internal consistency as an essentially unidimensional measure. A total score is recommended, and the six domains should be treated as a content framework rather than as separate subscales. Hypotheses testing, cognitive interviews with patients, and replication in independent samples are needed. This study was not registered.

Nursing Reports doi: 10.3390/nursrep16110384

Authors: Leah East Rebecca M. Jedwab Clint Moloney Aletha Ward Jessica Elliott

Background/Objectives: Chronic obstructive pulmonary disease (COPD) is a progressive respiratory condition requiring integrated care; however, care fragmentation and limited healthcare access remain significant barriers, particularly in geographically dispersed regions. Nurse-led models of care may support care coordination and access to services for people with chronic illness. This scoping review explored the literature on nurse-led models of care for people living with COPD, with a particular focus on rural, regional, and remote populations. Methods: Five databases (EmBase, Informit, MEDLINE, CINAHL Ultimate, and Scopus) were searched on 9 July 2026. Using Covidence software, two researchers independently screened 116 records at title and abstract level, and 24 at full-text level. Data extraction was also completed independently by two researchers and data were synthesised using thematic analysis and narrative synthesis. Reporting of this scoping review was guided by The Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews checklist. Results: Only six studies met the eligibility criteria and were included in this review. Studies described nurses’ roles and contributions, coordination, continuity, and patient engagement, while reported outcomes included clinical, psychosocial, and service-level impacts. Conclusions: Included studies reported favourable outcomes associated with continuity of care, patient experience, symptom management, self-management, and hospital utilisation. However, the heterogeneity and methodological characteristics of the available evidence preclude conclusions regarding effectiveness, causality, or an optimal nurse-led model of care.

Nursing Reports doi: 10.3390/nursrep16110383

Authors: Alberto González-García Elena Andina-Díaz Silvia Pérez-González

Background/Objectives: Assessing artificial intelligence (AI) acceptance may help identify questions for nursing education, but similar overall scores need not reflect similar response patterns. We compared general AI acceptance in healthcare professional samples from Spain and Henan Province, China, including a substantial nursing subgroup. Methods: This exploratory cross-sectional comparison used data from two convenience-sampled online surveys involving 7187 respondents (Spain, 3764; Henan, 3423), including 3590 nurses. We examined a five-item acceptance composite using ordinal confirmatory factor analysis, measurement invariance testing, observed and adjusted comparisons, and equivalence testing with bounds of ±0.20 pooled standard deviations. Results: Observed means were 3.59 in Spain and 3.56 in Henan; the difference of 0.028 points fell within the exploratory equivalence bounds (90% CI −0.010 to 0.067; bounds ±0.195), whose practical significance has not been established. Metric and scalar constraints met change-in-fit criteria, although absolute fit was mixed and strict invariance was not supported. The scalar model yielded an exploratory latent Henan–Spain contrast of 0.227 reference-group standard deviations (95% CI 0.152 to 0.302), which requires caution given the mixed model fit. The adjusted composite difference was 0.114 points (95% CI 0.054 to 0.173). Item-level differences ran in opposing directions. In the exploratory nursing subgroup analysis, the adjusted Henan–Spain difference was 0.081 points (95% CI −0.014 to 0.176; Holm-adjusted p = 0.283). The interval included zero and positive differences; nurse-specific equivalence was not tested. Conclusions: Similar observed averages concealed heterogeneous responses in these samples. The findings support examining distinct aspects of acceptance when designing nursing-focused needs assessments, not assuming competence or readiness for a particular AI tool. Non-probability recruitment and incomplete cross-cultural validation limit generalization and interpretation. Registration: The study was not registered.

Nursing Reports doi: 10.3390/nursrep16110382

Authors: Martín Rodríguez-Álvaro Antonio Cabeza-Mora Domingo-Ángel Fernández-Gutiérrez Janet Núñez-Marrero Alfonso-Miguel García-Hernández Willian-Jesús Martín-Dorta Cristo-Manuel Marrero-González Pedro Ruymán Brito-Brito

Background/Objectives: The care provided to people with high-complexity chronic diseases requires knowing their longitudinal evolution and care needs. This study describes population-level longitudinal patterns of nursing care needs among highly complex chronic patients in the Canary Islands (Spain) and analyses the associations between nursing diagnoses and sociodemographic, clinical and contextual variables. Methods: A retrospective and population-based cohort study with yearly follow-up (2016–2024) was conducted. The subjects included were 92,855 patients classified as presenting high/very high complexity in Primary Health Care. Sociodemographic and clinical variables were analysed, as well as use of health resources and 40 NANDA-I nursing diagnoses duly recorded in electronic health records. Descriptive, bivariate and multivariate analyses were performed by means of generalized estimating equations. Results: The cohort was predominantly female, with a mean age of 70.5 years old. Approximately 44% of participants died during follow-up. Arterial hypertension, diabetes, osteoarthritis, polypharmacy and frailty prevailed. The most frequent diagnoses were as follows: readiness for enhanced health self-management; impaired skin integrity; high-complexity chronic patient frailty syndrome; impaired urinary elimination; and risk for falls. In the multivariate model, gender, age, complexity and province showed independent associations with different diagnostic patterns, whereas time was especially related to frailty, risk for falls, discomfort and self-care deficit. Conclusions: These patients show heterogeneous population-level temporal patterns in documented nursing care needs, highlighting the value of standardised nursing terminology and longitudinal follow-up to inform individualised care planning in Primary Health Care. Geographical variations in recorded nursing diagnoses may partly reflect differences in clinical documentation practices rather than solely differences in underlying care needs.

Nursing Reports doi: 10.3390/nursrep16110381

Authors: Petros Galanis Ioannis Moisoglou Angeliki Triantafillaki Venetia Sofia Velonaki Theodoros Pesiridis Aglaia Katsiroumpa

Background/Objectives: Negative workplace gossip has been linked to nurses’ mental health and professional life. The aim of this study was to examine the association between perceived negative workplace gossip, mental health and professional life among nurses. Methods: A cross-sectional study was conducted in Greece during May 2026. We used validated scales to measure the study variables: Perceived Negative Workplace Gossip Scale, Patient Health Questionnaire-4, Quiet Quitting Scale, Utrecht Work Engagement Scale-3, Organization-Based Self-Esteem Scale, Single-Item Job Satisfaction measure, and Single-Item Burnout measure. Also, we used a single-item measure to examine nurses’ turnover intention. Results: We found a significant positive association between perceived negative workplace gossip and both anxiety (p = 0.012), and depression symptoms (p < 0.001). Moreover, multivariable linear regression analysis identified a positive association between perceived negative workplace gossip and three dimensions of quiet quitting; (1) detachment (p = 0.001), (2) lack of initiative (p < 0.001), and (3) lack of motivation (p < 0.001). Also, we found a positive association between perceived negative workplace gossip and job burnout (p = 0.009). Multivariable linear regression analysis showed a negative association between perceived negative workplace gossip and work engagement (p < 0.001), organization-based self-esteem (p < 0.001), and job satisfaction (p < 0.001). Additionally, multivariable logistic regression analysis showed that higher level of perceived negative workplace gossip was associated with higher odds of turnover intention (p = 0.001). Conclusions: Perceived negative workplace gossip showed statistically significant but small associations with anxiety, depression, quiet quitting, work engagement, organization-based self-esteem, job satisfaction, job burnout, and turnover intention. Given the cross-sectional design, these associations do not establish causality. Our results support attention to the relational climate of nursing units, while longitudinal and intervention studies are needed to determine whether reducing negative workplace gossip improves nurses’ mental health and professional outcomes.

Nursing Reports doi: 10.3390/nursrep16110380

Authors: Jongmi Seo Sumiyo Brennan Tomoko Sugimoto

Background/Objective: Dementia-care-related strain can affect care professionals’ well-being, retention, and long-term care quality. However, no Japanese-language instrument specifically assesses such strain among care staff. This study translated and culturally adapted the Strain in Dementia Care Scale (SDCS) for Japanese care staff and evaluated the content validity of the Japanese version (J-SDCS). Methods: This methodological study comprises two phases. First, the SDCS underwent forward translation, reconciliation, back-translation, review by the original developer, and a written clarification test with care staff. Second, eight gerontological experts assessed content validity using a five-point rating scale (1 = not valid to 5 = valid). Ratings of 4 or 5 were classified as favorable. Item-level and scale-level content validity indices (I-CVI and S-CVI) were calculated. Results: The adaptation process identified linguistic and cultural issues, including potentially ambiguous wording in Item 4 and a culturally dependent example in Item 21, which was removed while retaining the core statement. All 27 items were retained. The S-CVI/Ave was 0.93 for the frequency component and 0.91 for the stress component, whereas the S-CVI/UA was 0.63 and 0.44, respectively. Several items had I-CVI values below the reference value of 0.78. Item-level decisions considered expert ratings and comments, feedback from intended respondents, and consistency with the original SDCS. Conclusions: The multistep adaptation process provided initial evidence supporting the content validity and cultural appropriateness of the J-SDCS. However, potential item ambiguity, cultural adaptation decisions, and limitations of the content validity assessment warrant cautious interpretation. Further research is needed to evaluate structural validity, reliability, construct validity, and cross-cultural measurement equivalence.

Nursing Reports doi: 10.3390/nursrep16110379

Authors: Hugo Abad-Taboada Alexandro Domínguez-Padilla Alberto José Gómez-González Borja Fernández-Herrera Oleksandr Fedotov-Kryzhanivskiy Álvaro Abad-Taboada Marina Muñoz-Lupiáñez Ada del Mar Carmona-Segovia Marta González-García

Background/Objectives: Pressure injuries (PI) are one of the most frequent adverse events in hospitalised patients, with significant implications for quality of life and healthcare costs. While PI prevention knowledge has been studied in nursing professionals, evidence among nursing students remains limited, with only one prior study published in Spain. This study aimed to assess PI prevention knowledge and attitudes among third- and fourth-year nursing students at the University of Málaga in relation to academic and sociodemographic variables. Methods: An analytical cross-sectional design with convenience sampling was employed. Knowledge and attitudes were evaluated using the validated PIPK and APuP questionnaires. A total of 261 subjects participated (data collected December 2024–February 2025). Ethical approval: CEUMA Nº 183-2023-H. Results: Participants scored a mean of 76.03% of the maximum on the knowledge questionnaire (SD 8.29) and rated their own knowledge at 7.04 out of 10. A positive attitude toward PI prevention was found in 79.7% of them. A statistically significant positive correlation was observed between attitude and knowledge level (r = 0.175, p = 0.005). Knowledge gaps showed a statistically significant inverse relationship with knowledge level (r = −0.624, p < 0.001). Mean differences in knowledge according to sex and academic year were also significant (p = 0.044 and p = 0.004, respectively). Linear regression (R2 = 0.082) identified sex, academic year, and attitude as significant associations of PI prevention knowledge level. Conclusions: The mean knowledge score was 76.03%, and most students had a positive attitude toward prevention. Fourth-year students scored higher than third-year students. Because the study was cross-sectional, it describes this cohort at one point in time and cannot assess the effect of training.

Nursing Reports doi: 10.3390/nursrep16110378

Authors: Nuria Alcolea-Ruiz Candelas López-López Teresa Pérez-Pérez Sonia Alcolea Emma Camino-Ortega Francisco Javier Pérez-Rivas

Background/Objectives: This exploratory secondary analysis described outdoor footwear among older adults with concern about falling (CaF), examined baseline associations, evaluated a nurse-led intervention, and explored associations with CaF and falls. Methods: Data came from 163 community-dwelling adults aged ≥ 65 years in the FEARFALL_CARE cluster-randomised trial across ten primary care centres. Footwear was observed at baseline and six months using an unvalidated four-criterion composite. Mixed-effects models were complemented by inverse probability weighting (IPW) and cluster-level sensitivity analyses. Results: At baseline, 37/163 randomised participants (22.7%; composite available for 158) wore footwear meeting all criteria. Female sex and dwelling type were associated with baseline classification in an exploratory model. The ground-level house category contained only six participants. At six months, 18/59 intervention participants (30.5%) and 12/69 controls (17.4%) met all criteria. The adjusted intervention estimate was imprecise (aOR = 1.92; 95% CI: 0.78–4.69; p = 0.151), as were the IPW estimate (aOR = 2.18; 95% CI: 0.91–5.24; p = 0.081) and the adjusted cluster-level difference (9.3 percentage points; 95% CI: −9.6–28.2; p = 0.290). Baseline classification was associated with follow-up classification (aOR = 4.24; 95% CI: 1.65–10.92; p = 0.002). No statistically significant association was detected between footwear classification trajectory and six-month Short FES-I scores (p = 0.808) or experiencing at least one fall (p = 0.884). Conclusions: Failure to meet predefined footwear criteria was common. Sensitivity analyses did not establish an intervention effect, and imprecision precludes concluding absence of benefit or of associations with CaF and falls. The prevalence of potentially modifiable characteristics supports considering footwear assessment within multifactorial fall-risk evaluation.

Nursing Reports doi: 10.3390/nursrep16110377

Authors: Gustavo Gonçalves dos Santos Anna Paula Mendes Marques de Lima Franco Francini Castilha do Nascimento Letícia Eduarda de Oliveira Maria Julia Cunha Silva Lima Joaquim Guerra de Oliveira Neto Wágnar Silva Morais Nascimento Marcelo Víctor Freitas Nascimento Pedro Vitor Mendes Santos Leticia de Almeida Dionizio Maria João Jacinto Guerra Júlia Maria das Neves Carvalho Ana Cristina Ribeiro da Fonseca Dias Maria Luísa Santos Bettencourt Isabelle Cristinne Pinto Sampaio Costa

Background: The use of digital health technologies, such as chatbots and virtual assistants based on artificial intelligence, has grown significantly in maternal health. These tools have been applied at different stages of the pregnancy and postpartum cycle, with emphasis on health education, risk monitoring, breastfeeding support, and mental healthcare. Despite their potential, challenges remain regarding clinical effectiveness, equity of access, and ethical safety. The aim of this study was to map the available evidence regarding the applications of artificial intelligence in pregnancy, childbirth, and postpartum care, with particular emphasis on conversational agents, virtual assistants, machine learning models, and clinical decision support systems, as well as their potential benefits, limitations, ethical implications, and implementation challenges. Methods: A scoping review was conducted between August and September 2025 in PubMed, Scopus, Web of Science, Nursing Database, Latin American and Caribbean Literature in Health Sciences, and Google Scholar. Original articles, reviews, experience reports, and theoretical reflections published in Portuguese, English, or Spanish that addressed the use of digital tools based on artificial intelligence in the pregnancy and postpartum cycle were included. The analysis of the studies was organized into five thematic axes: applications in prenatal care; support during childbirth; postpartum monitoring and breastfeeding; perinatal mental health; and ethical, technical, and implementation challenges. Results: The search identified 6230 records, of which 13 studies were included. Findings indicate that chatbots and virtual assistants show good acceptability, promote health education, and contribute to the early detection of physical and emotional risks. However, most of the studies are exploratory, with methodological limitations, lack of clinical trials, and limited validation in socially vulnerable contexts. Conclusions: Chatbots and artificial intelligence tools are promising resources for perinatal care, particularly as a complement to face-to-face attention. Their consolidation requires robust studies, cost-effectiveness assessments, and public policies that ensure equity and digital inclusion.

Nursing Reports doi: 10.3390/nursrep16110376

Authors: Alaa Mahsoon Yousef Alharthi

Background/Objectives: Compassion fatigue (CF), commonly discussed alongside burnout and secondary traumatic stress, is an important occupational concern in nursing. General and psychiatric hospital environments expose nurses to different combinations of organizational, emotional, and relational demands. This systematic review aimed to synthesize and compare the reported patterns, determinants, and consequences of compassion fatigue among nurses working in general and psychiatric hospital settings and to identify setting-specific factors relevant to nursing practice and workforce support. Methods: The review was conducted in accordance with PRISMA 2020. PubMed, CINAHL, PsycINFO, and Scopus were searched for peer-reviewed studies published from 2020 to 2025. Quantitative and qualitative hospital-based nursing studies reporting CF or closely related professional-quality-of-life constructs were eligible. Methodological quality was appraised using Joanna Briggs Institute critical appraisal tools, and findings were synthesized narratively because of heterogeneity in study designs, instruments, and reporting formats. Results: Eighteen studies were included after screening 302 records identified in the database searches. Moderate-to-high CF-related burden was reported across both general and psychiatric settings, but direct prevalence comparisons were not appropriate because instruments, definitions, and thresholds differed substantially. General-hospital studies more often emphasized workload, high acuity, staffing pressures, sleep disruption, and acute trauma exposure, whereas psychiatric studies more often emphasized moral distress, aggression or workplace violence, stigma, and prolonged emotionally demanding therapeutic relationships. Across settings, CF was associated with poorer psychological and occupational well-being. Conclusions: The available evidence supports setting-sensitive prevention and workforce-support strategies but does not establish that one hospital setting has a uniformly higher prevalence of CF. More consistent definitions, measurement tools, and reporting thresholds are needed to enable reliable cross-setting comparisons.

Nursing Reports doi: 10.3390/nursrep16110375

Authors: Carlos Enrique Adán-Failde Ana Presa-Carrera Eva Luyufeng Yáñez-Izquierdo Juan Manuel Vázquez-Lago

Background/Objectives: Nutrition knowledge is an important component of undergraduate nursing education, but greater knowledge does not necessarily translate into healthier personal behaviors. This study aimed to assess nutrition knowledge and health-related behaviors among undergraduate nursing students, compare these outcomes across academic years, and identify factors associated with both dimensions. Methods: A cross-sectional study was conducted among students enrolled in the four-year nursing degree at the University of Santiago de Compostela, Spain, during the 2025/2026 academic year. Participants completed a study-specific ad hoc questionnaire assessing sociodemographic characteristics, nutrition knowledge, dietary and health-related behaviors, self-rated dietary quality, and body mass index (BMI) perception. Bivariate analyses, multiple linear regression, ordinal logistic regression, and weighted Cohen’s kappa were used. Results: A total of 297 students participated (50.9% response rate); 81.1% were women. Mean nutrition knowledge was 22.51 ± 4.01/36 and differed across academic years, ranging from 21.56 ± 3.74 among first-year students to 24.64 ± 3.87 among fourth-year students (p < 0.001). The mean health-related behaviors score was 76.26 ± 7.01/105 and did not differ across academic years (p = 0.103). Behavior score increased from 68.33 ± 7.78 among students rating their diet as poor to 84.81 ± 4.32 among those rating it as very good (p < 0.001); each 10-point increase was associated with higher odds of reporting a better dietary-quality category (adjusted OR = 7.78; 95% CI: 4.99–12.13). Exact agreement between calculated and self-perceived BMI categories was 82.7% (weighted κ = 0.593). Conclusions: Nutrition knowledge was higher among students in later academic years, whereas health-related behaviors did not show a similar academic pattern. These findings suggest that undergraduate nursing education should reinforce practical and behavior-oriented nutrition learning alongside theoretical knowledge.

Nursing Reports doi: 10.3390/nursrep16100374

Authors: Erica Busca Ines Basso Melania Stedile Mattia Bellan Fabiola De Marchi Dino Stefano Di Massimo Giovanna Rodella Cinzia Rollino Antonio Scalogna Rosanna Vaschetto Erika Bassi Alberto Dal Molin

Background/Objectives: Caregivers play a central role in ensuring the safety of community-dwelling older adults receiving home-based care, yet gaps remain in ongoing educational support and communication with professionals. This protocol describes a two-phase study to customise an existing platform for use as a mobile health (mHealth) intervention supporting caregivers in delivering safer home-based care and Family and Community Nurses (FCNs) in supporting them, and to evaluate its feasibility, acceptability and usability. Methods: Phase 1 will apply a User-Centred Design (UCD) approach, articulated into four subphases, involving caregivers and a multidisciplinary panel of professionals from district-based health and social care services. Needs will be identified and prioritised through focus groups, informing the customisation and testing of the platform for use as an mHealth intervention. Phase 2 will adopt a convergent mixed-methods design within a Local Health Authority in Northern Italy, among a sample of at least 10 caregivers and a similar number of FCNs, over a 3-month data collection period. Acceptability and usability will be assessed as preliminary conditions for the adoption of a safety-oriented digital intervention, through quantitative self-reported measures, system-generated usage data, and semi-structured interviews. Conclusions: This study is expected to result in a customised platform for use as an mHealth intervention, together with preliminary evidence on its feasibility, acceptability and usability in supporting safer home-based care. Findings may inform future implementation strategies for digitally supported caregiving.

Nursing Reports doi: 10.3390/nursrep16100373

Authors: Adelaide D’Errico Gianluca Azzellino Biagio Nicolosi Emanuele Buccione Giorgia Grandville Camilla Elena Magi Laura Rasero Stefano Bambi Roberta Previdera

Background/Objectives: Transition from the Neonatal Intensive Care Unit (NICU) to home involves emotional adjustment and increasing parental responsibility for infant care. This study explored parents’ experiences of this transition, focusing on emotional experiences, perceived continuity of care, and support needs. Methods: A qualitative descriptive study included 38 parents representing 34 preterm or medically complex infants discharged from a single NICU in an Italian tertiary children’s hospital. Individual semi-structured interviews were conducted within 12 months of discharge, audio-recorded, and transcribed in Italian. Predominantly inductive thematic analysis examined shared meanings and variations across parents’ retrospective interview accounts. Recruitment was time-limited; neither saturation nor information power was formally assessed. Results: Four themes were developed: returning home with joy as the focus of fear changes; being with the infant and learning to provide care; remaining in contact without always feeling accompanied; and receiving support while needing space for parental distress. Joy and apprehension could coexist, with some parents describing relief or a shift from fear for the infant’s health to concerns about independent caregiving. Useful practical instruction did not always translate into feeling prepared, while continuing professional contact could coexist with gaps in coordination between services. Staff, family, and peer support were valued alongside requests for dedicated attention to parental distress. Conclusions: Parents’ accounts highlighted the importance of support responsive to individual needs throughout the transition. Priorities for service development include supported participation in care, individualized discharge preparation, coordination across hospital and community services, and access to psychological support.

Nursing Reports doi: 10.3390/nursrep16100372

Authors: Dhurata Ivziku Luca Vollero Viviana Alciati Federica Maria Pia Ferramosca Viviana Cotichini Francesca Reato Marzia Lommi Daniela Tartaglini

Background/Objectives: Nursing workforce shortages and increasing care complexity have intensified the need to understand how registered nurses allocate their working time and whether nursing expertise is used where it adds the greatest clinical value. This study empirically measured the distribution, frequency, and duration of observed nursing activities and examined differences across participating hospitals and medical–surgical units in Italy. Methods: A multicentre observational study was conducted across 13 medical and surgical units in five Italian teaching hospitals. Registered nurses were observed during complete morning and afternoon shifts over a three-week period. Activities were classified as direct care, indirect care, organisational activities, or non-patient care. Time allocation, activity frequency, and duration were examined across units and hospitals. The Enacted Scope of Practice model, Role Theory, and Job Demands–Resources Theory informed interpretation of the findings but were not used to classify individual activities. Results: Overall, 45% of cumulative recorded activity time was devoted to direct care, 24% to indirect care, 10% to organisational activities, and 21% to non-patient care. Direct care accounted for 51% of recorded activity time in medical units and 41% in surgical units, whereas indirect care represented 17% and 28%, respectively. Considerable hospital-level variability was observed, particularly for indirect, organisational, and non-patient care activities. Direct care was also the most frequent activity category, while organisational activities were less frequent but comparatively time-intensive. Conclusions: Nursing work extends substantially beyond bedside care and includes clinically relevant indirect and organisational activities. Interpreted through the Enacted Scope of Practice framework, the findings identify areas requiring further competency-based evaluations to support work redesigning that protects activities requiring registered nursing expertise, redistributes appropriate tasks, and reduces avoidable organisational inefficiencies.

Nursing Reports doi: 10.3390/nursrep16100371

Authors: Aseel Mohammad Alzean Abdulkareem S. Iblasi Hassan Al Buraiki Yupin Aungsuroch I Gede Juanamasta

Background/Objectives: Pressure injuries remain an important patient-safety concern, and their prevention depends on accurate knowledge among nursing staff. This review estimated the effect of technology-enhanced learning (TEL) on pressure injury knowledge among nurses and nursing students. Methods: Following PRISMA 2020, MEDLINE (via PubMed), Scopus, CINAHL, and CENTRAL were searched for studies published from 2000 to 2026 (final searches 7 October 2026). TEL was defined as instruction in which digital technology formed an integral component. Controlled studies reporting continuous knowledge scores were pooled with a random-effects model (Hedges’ g); risk of bias was assessed with RoB 2, ROBINS-I, and the NHLBI tool, and certainty of evidence with GRADE. Results: Five studies were included; three controlled studies (N = 277) contributed to the meta-analysis. TEL was associated with higher post-intervention knowledge than comparator conditions (g = 1.33, 95% CI 0.98–1.69; I2 = 41.5%). The effect remained significant with the Hartung–Knapp–Sidik–Jonkman adjustment (95% CI 0.55–2.12) and in leave-one-out analyses (g 1.17–1.49) and was smaller when an excluded physical-simulation trial was added (g = 1.19). Two studies synthesized narratively showed short-term gains in classification, attitudes, and knowledge, but no sustained classification advantage at three months. Certainty of evidence was low because of risk of bias and imprecision. Conclusions: TEL may improve short-term pressure injury knowledge among nurses and nursing students, but the small evidence base, varied comparators, and blended designs prevent attributing the effect to technology alone. Well-controlled trials measuring retention, clinical practice, and patient outcomes are needed.

Nursing Reports doi: 10.3390/nursrep16100370

Authors: Sarah Hassan Tawhari Regie Buenafe Tumala Yahya Hassan Tawhari

Background: Artificial intelligence (AI) is increasingly integrated into nursing practice, yet nurses often demonstrate low to moderate AI knowledge, mixed attitudes, and inconsistent practice behaviors. Although individual studies have examined these domains, no review has comprehensively examined AI-related knowledge, attitudes, and practice (KAP) together with the emerging evidence on patient safety culture among nurses. This gap is significant because safe AI adoption in nursing depends on both technical competence and a strong safety culture across diverse clinical settings. Objective: To systematically map international evidence on nurses’, nursing students’, and other included participants’ AI-related KAP, and to examine how these factors may relate to patient safety culture. Because several eligible studies included multidisciplinary samples in which nurse-specific quantitative data were not reported separately (China, Bangladesh, Pakistan, and three studies from the Kingdom of Saudi Arabia [KSA]), only studies with extractable nurse-specific results were used to inform nurse-focused conclusions, and multidisciplinary findings were not attributed solely to nurses. Methods: This scoping review followed Arksey and O’Malley’s framework and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Searches of PubMed, CINAHL, Scopus, Web of Science, and ScienceDirect (2021–2026) identified studies examining AI-related perceptions among nurses and other healthcare participants when nurse-specific data were reported separately or extractable. Data extraction and narrative synthesis were conducted using Joanna Briggs Institute guidance. Results: Ten studies met the inclusion criteria and were included in the final review. Studies from China, Bangladesh, Pakistan, the KSA, Turkey, and the United Arab Emirates showed variable AI knowledge but predominantly positive attitudes. Ethical concerns—privacy, job displacement, and reduced empathy—were common. Younger age, higher education, and prior AI exposure were associated with more favorable perceptions. Nurses across regions emphasized the need for structured AI training. Only one study examined patient safety culture, and it reported that AI knowledge and attitudes significantly predicted patient safety culture, with attitude showing the stronger effect. However, because this evidence comes from a single cross-sectional study conducted in a multidisciplinary sample without nurse-specific results, it is insufficient to establish causal conclusions, and its findings cannot be generalized specifically to nurses. Conclusions: Nurses are generally receptive to AI but lack sufficient knowledge, training, and organizational support for safe implementation. Preliminary evidence suggests a positive association between AI-related knowledge, attitudes, and patient safety culture, but this relationship remains uncertain due to the extremely limited evidence base and the reliance on evidence that is not exclusively nurse-specific. Available studies indicate generally favorable attitudes toward AI alongside variable knowledge, limited formal training, and persistent ethical and organizational concerns, with only one eligible cross-sectional study linking these factors to patient safety culture. The conclusion regarding this association should not be attributed exclusively to nurses because the patient safety culture evidence was derived from a multidisciplinary sample. Future research should explore how AI competencies may interact with safety-related behaviors and organizational systems. Strengthening AI training, ethical guidance, and organizational support remains essential for safe adoption.

Nursing Reports doi: 10.3390/nursrep16100369

Authors: Luís Loureiro Ana Teresa Pedreiro

Background/Objectives: Mental health literacy (MHL) is considered an important resource for promoting mental health, facilitating the recognition of mental health problems, reducing stigma, and encouraging appropriate help-seeking behaviours. Among undergraduate nursing students, MHL may also be associated with positive mental health and a greater willingness to seek professional support when needed. This study aimed to examine the associations between mental health literacy, positive mental health, and help-seeking intention among undergraduate nursing students. Methods: A correlational study was conducted with 388 nursing students (50.3% enrolled in the second year and 49.7% enrolled in the fourth year), predominantly women (84.0%), with a mean age of 21.76 years (SD = 5.00) and a median of 21.0 years. Results: Nursing students showed relatively high levels of mental health literacy, positive mental health, and help-seeking intention. Small but significant multivariate main effects of year of study and familiarity with mental illness, without interaction, were found on the combined set of global scores. In univariate follow-up analyses that remained significant after Bonferroni correction, students with high familiarity (both close contact with and personal experience of mental health problems) showed lower positive mental health, and fourth-year students reported higher help-seeking intention than second-year students; small differences in mental health literacy and mental health–promoting knowledge did not survive correction. Canonical correlation analysis identified a single significant, modest association between mental health literacy, mainly its attitudinal component and mental health–promoting knowledge, and positive mental health (Rc = 0.42; redundancy indices of 3.5% and 5.8%). In the hierarchical regression predicting help-seeking intention, knowledge of risk factors and causes and positive mental health dimensions (problem-solving and personal fulfilment, interpersonal relationship skills) were positive predictors, as were attitudes that promote recognition. Overall, the final model explained a modest proportion of the variance (R2 = 0.162; adjusted R2 = 0.126). Conclusions: Nursing students display an overall favourable profile of mental health literacy, positive mental health, and help-seeking intention, already high among second-year students; self-selection into the profession is one possible explanation that requires longitudinal confirmation. Differences by year of study and familiarity were small: fourth-year students reported higher help-seeking intention, and students with high familiarity reported lower positive mental health.

Nursing Reports doi: 10.3390/nursrep16100368

Authors: Alina Doina Tănase Camelia-Oana Mureșan Ștefania Dinu Adriana Pădure Codruța-Eliza Ille Cristina Ioana Talpoș Niculescu

Background and Objectives: Regulation (EU) 2024/1689, the Artificial Intelligence Act, requires organisations deploying AI systems to ensure appropriate AI literacy and human oversight. We examined whether AI legal literacy was associated with procedure-concordant use of an AI-enabled early-warning system among hospital nurses and whether the association of prior AI-governance training with concordant use persisted after literacy was taken into account. Materials and Methods: This single-centre cross-sectional study included 87 nurses in a tertiary university hospital. AI legal literacy was measured with a study-specific 24-item instrument, and procedure-concordant AI use, the primary outcome, was defined as meeting all five criteria of the institutional documentation audit in 10 audited interactions per nurse. The primary analysis was multivariable logistic regression, confirmed in three-level mixed-effects models of 870 audited interactions nested within nurses and wards. Secondary and exploratory analyses (inverse-probability weighting, mediation decomposition, latent class analysis, and an internally validated prediction model) are reported as hypothesis-generating. Results: Forty-four nurses (50.6%) were procedure-concordant. Concordance was higher among trained than untrained nurses (70.3% versus 36.0%; p = 0.002). Each 10-point increase in AI legal literacy was associated with higher adjusted odds of concordant use (adjusted odds ratio 5.16, 95% CI 2.04–13.06; p < 0.001). The association persisted in three-level mixed-effects models (aOR 3.61 per 10 points, 95% CI 1.98–6.58). The association with prior training was attenuated after adjustment for literacy and was not statistically significant after inverse-probability weighting (OR 2.01, 95% CI 0.82–4.90); an exploratory decomposition was consistent with, but could not establish, an indirect association through literacy. Conclusions: Higher AI legal literacy was strongly associated with procedure-concordant AI use in this single-centre study. The findings support further evaluation of literacy-focused governance education and institutional oversight in hospital nursing practice; causal and predictive claims await prospective, multicentre confirmation.

Nursing Reports doi: 10.3390/nursrep16100367

Authors: Velide Pulomemoj Anisa Subashi Arshad Mehmood Lorena Serjanaj Fatjona Kamberi

Background/Objectives: Multimorbidity renders self-efficacy a continuing partnership between older people, families, and healthcare and social care services. We examined whether nine domain-specific self-efficacy indicators were best understood as one overall level of confidence or as recurring configurations in which confidence was distributed differently across everyday tasks. The primary aim was to identify and interpret these configurations in older adults attending primary care in Vlora Municipality, Albania. Secondary aims were to evaluate the quality and reproducibility of the solution and to describe health literacy and six-month healthcare utilisation, without treating either as a cause or as a profile-defining variable. Methods: This verified secondary cross-sectional analysis used data from 464 community-dwelling adults aged 65 years or older with at least two chronic conditions recruited through five primary healthcare centres. After two questionnaire values were checked against the source records, 459 participants with complete nine-domain self-efficacy data formed the primary sample. We compared 40 Gaussian finite-mixture candidates: one to ten profiles under four covariance structures. Model choice used a combination of Bayesian information criterion (BIC), integrated completed likelihood (ICL), Akaike information criterion (AIC), entropy, average posterior probability, profile size, convergence, covariance diagnostics, interpretability, and reproducibility across 50 random starts. There is no single closed-form power calculation for profile enumeration; therefore, precision was assessed empirically with missing-item, domain-omission, and bootstrap checks. Health literacy and healthcare utilisation were kept outside profile formation and were described with conditional adjusted count models. Results: The retained exploratory Profile-specific full-covariance model (VVV) two-profile solution had 249 and 210 participants (mclust BIC = −8125.080; ICL = −8181.987; AIC = 7675.013). Assignment quality was reasonably precise (entropy = 0.814; average posterior probabilities = 0.961 and 0.931), but the profile solution was not simply a low-to-high severity scale. One pattern was stronger for finding information, obtaining support, and communicating with physicians; the other was stronger for exercise, household and social activities, symptom management, and emotional management. In 100 bootstrap refits, the adjusted Rand index ranged from 0.212 to 0.865 (median 0.584), so stability was moderate. After covariate adjustment, Profile 2 had a modelled general-practitioner visit rate that was 19% lower than Profile 1 [incidence rate ratio (IRR) = 0.809; 95% confidence interval (CI) 0.687–0.953; p-value = 0.011]; this is an exploratory association conditional on the fitted model, not evidence of a causal effect. Conclusions: A profile can show how confidence is organised across daily self-efficacy tasks even when two groups have similar overall means. For health and social care, the findings support assessment that links information and communication with activity, symptom management, emotional wellbeing, family support, and community resources. The profiles are exploratory conversation prompts rather than diagnostic categories, and the cross-sectional data do not show that self-efficacy causes healthcare use.

Nursing Reports doi: 10.3390/nursrep16100366

Authors: Desirée Mena-Tudela Josefina Goberna-Tricas Susana Iglesias-Casás Irene Llagostera-Reverter Ainoa Biurrun-Garrido

Background/Objectives: The aim of this study is to analyse the association between sociodemographic and obstetric characteristics and perceived or suspected obstetric violence in Spain, informed by an intersectional framework. Methods: A cross-sectional study was conducted using a non-probabilistic online survey of women who gave birth in Spain between March 2020 and April 2021. “Yes” and “do not know” responses were combined as perceived or suspected obstetric violence. Descriptive and bivariate analyses (chi-squared and Fisher’s exact tests) were followed by a multivariable binary logistic regression including, a priori, age, occupation, educational level, social class, ethnicity, type of birth, type of healthcare and autonomous community. Results: Of 6060 women, 33.5% (n = 2030) reported or suspected obstetric violence. In the adjusted model (n = 5978; Nagelkerke R2 = 0.071), the outcome was associated with all variables except social class. Odds were higher after urgent caesarean section (aOR = 2.16) and instrumental birth (aOR = 2.76) than after vaginal birth, and lower in private than in public healthcare (aOR = 0.67). Estimates for ethnic minorities were very imprecise because of the small size of these groups. Conclusions: Perceived or suspected obstetric violence was associated with several sociodemographic, obstetric and healthcare characteristics, most strongly with type of birth, although the explanatory capacity of the model was low. These findings support reviewing interventionist obstetric practices and using sampling strategies that include minority groups.

Nursing Reports doi: 10.3390/nursrep16100365

Authors: Rosemary Michael Malya Michael Johnson Mahande Kristin Hjorthaug Urstad Bodil Bø Jane Rogathi

Background: Although simulation-based education is reported to improve nursing and midwifery students’ clinical competencies, evidence regarding knowledge retention remains limited, particularly in low-resource settings. This study evaluated two-year knowledge retention following simulation-based education in initial neonatal care among nurse-midwives in Tanzania. Methods: This is a two-year follow-up of a quasi-experimental study conducted in June 2025 among 84 nurse-midwives: 43:41 to the intervention and control groups. Participants were among the 90 second-year diploma nursing and midwifery students from a quasi-experimental reference study conducted between March and June 2023, with 45 students in the intervention group and 45 in the control group. Both study groups received lectures, while the intervention group received additional simulation-based education on initial neonatal care. Data were collected using a structured, electronic questionnaire—the same questionnaire employed in the reference study. Data were analyzed using descriptive statistics, paired t-test, McNemar’s exact test, and Generalized Linear Mixed Models. Results: After two years of simulation-based education on initial neonatal care, knowledge declined in both groups but remained higher in the intervention group (16.3 vs. 12.7), with higher knowledge retention (7.2 vs. 4.2 points). The adjusted difference-in-differences analysis showed no significant long-term effect of simulation on knowledge retention (aDiD = 0.06; 95% CI: −1.47 to 1.60; p = 0.935). Conclusions: The intervention group had higher observed knowledge scores at follow-up, but the study did not demonstrate a statistically significant differential long-term effect of the single SBE intervention. Implication: Integrating simulation-based education into nursing curriculum and professional training may enhance knowledge retention.

Nursing Reports doi: 10.3390/nursrep16100364

Authors: Leila Sales Bárbara Marques Ângela Mendes Florbela Machado Inês Lopes Rita Marques

Background: Cardiopulmonary resuscitation (CPR) requires a coordinated and effective response, with non-technical skills (NTS) playing an important role in patient safety. Deficiencies in these skills may contribute to preventable clinical errors. Objectives: To map the scientific evidence on the contribution of simulation to the development of NTS among healthcare teams in the context of CPR. Methods: This scoping review followed JBI guidance and PRISMA-ScR reporting recommendations. MEDLINE, CINAHL, Nursing & Allied Health Collection: Comprehensive and the Cochrane Central Register of Controlled Trials were searched via EBSCOhost up to 7 July 2026. Eligibility followed Population, Concept and Context criteria; two reviewers independently selected and charted the evidence. Results: The 27 included sources yielded three themes: simulation as a strategy for skill development; NTS in CPR; and complementary educational interventions. Communication was the most frequently reported NTS, alongside leadership, teamwork, situational awareness, and decision-making. Reported improvements varied across sources and skills, and some diminished or were only partially retained over time. Debriefing was addressed in 21 sources (77.8%). Evidence on complementary technologies remained preliminary, with some tools lacking formal evaluation or validation. Conclusions: The findings provide a descriptive map of heterogeneous evidence and suggest that simulation may support NTS development, particularly with structured debriefing. They do not establish effectiveness or effects on clinical outcomes. Robust quantitative and longitudinal studies using validated measures are needed to confirm observed trends and assess retention, transfer to practice, team performance, patient safety, and clinical outcomes.

Nursing Reports doi: 10.3390/nursrep16100363

Authors: Marcio Jiménez-Gutiérrez Elizabeth Vargas-Rosero Gloria Mabel Carrillo-González María de los Ángeles Torres-Lagunas Guillermina Arenas-Montaño Irma Cortés-Escárcega Rosa María Ostiguín-Meléndez

Background/Objectives: To analyze the concept of “care practices” as an abstract, relevant element of interest to the nursing discipline. Methods: The Walker & Avant methodology was followed, a structured eight-stage process that ranges from the choice of the concept and the identification of its essential features to the creation of comparative examples (cases) and the definition of their practical effects. The analysis was based on the paradigm of simultaneity, a vision that breaks with the traditional biomedical model, to understand the human being as an indivisible unit. Recognizing the tension between the analytical-positivist roots of the method and the chosen paradigm, Walker & Avant was used in an adaptive, heuristic way. Results: Based on the review of 12 predominantly qualitative articles, “care practices” are defined as actions aimed at solving needs in situations of vulnerability through an interpersonal bond influenced by the environment. Five defining dimensions were identified: awareness of vulnerability, activities in the intersubjective human bond, influence of the environment, recognition of intersectionality without judgment, and the active care of the self. Conclusions: Concept analysis provides nursing with scientific rigor, allowing for the delimitation of its scope and grounding its practice. “Care practices” transcend a mere activity to become a profound human encounter based on the recognition of shared vulnerability, involving not only healthcare personnel but human beings in general.

Nursing Reports doi: 10.3390/nursrep16100362

Authors: Olivia Mauerhofer Kimberley Ann Jones Tess Bright Skye Stewart Rebekah Julian Helen Lucy Henderson Shakira Onwuka Danielle Cameron Caroline Atkinson Helen Herrman Catherine Chamberlain

Background/objectives: Hospital settings can be unsafe for Aboriginal and Torres Strait Islander peoples, creating healthcare access barriers and perpetuating cycles of inequity. Healthcare service providers play a critical role in improving health equity. The Healing the Past by Nurturing the Future project (HPNF) delivered a training programme that aimed to improve service providers’ awareness, skills, and confidence in providing culturally safe, trauma-informed care. Methods: A mixed-methods evaluation assessed the acceptability and changes in self-reported knowledge, attitudes and practice (KAP) of one-day, face-to-face training sessions delivered at a large tertiary hospital in regional Victoria, Australia, from November 2023 to December 2024. Self-reported knowledge, attitudes, and practices were measured on a five-point Likert scale pre-training, post-training, and three months post-training. Participant perspectives were collected through evaluation forms and analysed using an inductive framework approach. Results: A total of 547 service providers participated in one of 38 training sessions. Responses to a KAP survey designed for this study showed positive changes in self-reported knowledge, attitudes and practice immediately after training that remained after three months among the smaller number of people that completed the survey. Participants expressed a need and desire for the training. Many highlighted new learning relating to Aboriginal and Torres Strait Islander culture, Australian history, colonisation, and the neurobiology of trauma. Conclusions: Aboriginal co-designed face-to-face culturally safe trauma-informed training is highly acceptable for service providers. The HPNF training was followed by positive changes in service providers’ self-reported knowledge, attitudes, and practices in working in a safe and sensitive manner with Aboriginal and Torres Strait Islander peoples. Such training may contribute to changes in health service providers’ capability to provide culturally responsive and trauma informed care. This may reduce healthcare access barriers and contribute to closing the gap in health and wellbeing outcomes and improve health equity.

Nursing Reports doi: 10.3390/nursrep16100361

Authors: Nopporn Vongsirimas Phunagphet Kesornsamut Wareerat Thanoi Sirada Kesornsri Sudarat Pianchob Sathaka Pimruen Nirunya Narupan Piyanee Klainin-Yobas

Background/Objectives: The Depression, Anxiety, and Stress Scales–21 (DASS-21) is widely used to assess psychological distress, but its factor structure may vary across contexts. This study evaluated the factor structure and construct validity of the Thai DASS-21 among Thai young people. Methods: In this cross-sectional study, 220 Thai young people aged 12–24 years completed the DASS-21 and measures of psychological well-being, mindfulness, and suicide risk. Exploratory factor analysis used principal axis factoring with unrestricted, two-factor, and three-factor solutions; oblimin rotation was used for the specified solutions. FA-based parallel analysis was conducted. Confirmatory factor analysis of ordinal items compared one-factor, two-factor, and original three-factor models in the same sample. Results: EFA showed substantial common variance across items. Mean-eigenvalue parallel analysis suggested five factors, with a dominant first factor. Among the specified EFA solutions, the two-factor solution was more interpretable and explained 44.09% of the variance. CFA fit indices favored the two-factor Distress and Depression model over the one-factor model; fit was comparable to the original three-factor model, with fewer free parameters. Distress and Depression scores correlated negatively with psychological well-being (r = −0.54 and −0.71, respectively) and mindfulness (r = −0.73 and −0.64, respectively), and positively with suicide risk (r = 0.46 and 0.45, respectively; n = 71). Conclusions: The Thai DASS-21 showed a strong general distress component with partial differentiation into related Distress and Depression factors. Findings do not establish strict unidimensionality or justify replacing subscale scores with the total score. Independent replication is required.

Nursing Reports doi: 10.3390/nursrep16100360

Authors: Diana Patricia Londoño Buriticá Brenda Yuliana Herrera-Serna Consuelo Vélez Álvarez

Introduction: A syndemic is characterised by the co-occurrence, clustering, and adverse interaction of multiple diseases in populations affected by social disadvantage. The diabetes–depression dyad is increasingly examined through this lens, yet its social determinants remain fragmented and rarely translated into nursing-relevant guidance for marginalised populations. This scoping review aimed to map the structural and intermediary social factors associated with the diabetes–depression dyad within the syndemic framework and to describe how biosocial interaction has been conceptualised and operationalised. Methods: Following the Joanna Briggs Institute methodology and reporting using PRISMA-ScR, we searched Scopus, Web of Science, PubMed, ScienceDirect, CINAHL, PsycINFO, Embase and Google Scholar up to 20 September 2026, with no restrictions on language, design, or year. We interpreted findings using an adapted VIDDA framework aligned with the WHO model of Social Determinants of Health. Results: Thirty-five publications (2012–2026) were included. Structural violence, poverty, displacement and migration were the most frequently reported structural determinants, whereas access to health services, neighbourhood conditions and interpersonal abuse were the most frequent intermediary factors. Biosocial interaction was formally tested in only a minority of studies, mainly through additive or multiplicative models; most publications documented co-occurrence or association rather than demonstrated synergy. Conclusions: Social determinants are central to the diabetes–depression syndemic in vulnerable groups, yet the evidence remains conceptually rich but empirically uneven, with few studies formally testing biosocial interaction. For nursing practice, these findings support pairing routine glycaemic and mood assessment with structured screening for social needs, coordinating integrated care, and delivering culturally safe, person-centred support. The included studies did not directly evaluate whether such nurse-led, socially informed care reduces health inequities; longitudinal and interventional research is needed to test this.

Nursing Reports doi: 10.3390/nursrep16100358

Authors: Aliya Zhylkybekova Gulbakit K. Koshmaganbetova Kulman Nyssanbayeva Bayan Nurgaliyeva Gulbanu Mukishova Azhar N. Zhexenova Lida Aliyeva Nurgul Ablakimova Andrej M. Grjibovski Natalya Glushkova

Background: Informal caregivers play a central role in supporting older adults with functional limitations, yet caregiving may impose substantial physical, psychological, social, and occupational demands. Objectives: This study aimed to explore caregiving experiences, sources of burden, and unmet healthcare and social support needs among informal caregivers of older adults with high caregiver burden. Methods: This qualitative study represented the second phase of a sequential explanatory mixed-methods study. Ten caregivers were purposively selected from the preceding quantitative phase based on a high caregiver burden, Caregiver Strain Index Plus (CSI+) score ≥ 7. In-depth semi-structured interviews were conducted in Kazakh or Russian across four cities of Kazakhstan and analyzed using inductive reflexive thematic analysis. Results: Six themes were identified: (1) physical and psychological impact of caregiving; (2) work–care balance and social isolation; (3) gender roles in the care of older adults; (4) insufficient support from healthcare and social services; (5) unmet caregiver needs; and (6) limited awareness of available support and services. Participants described increasing physical and emotional strain, disruption of employment and social life, and gendered expectations surrounding family caregiving. They also reported limited professional guidance and recognition, unmet needs for respite and practical assistance, and limited awareness of available health and social services, with informal networks and online sources often used to obtain information. Conclusions: Strengthening caregiver support within primary healthcare and improving access to information, practical assistance, and respite services may help address the needs identified among caregivers with high caregiver burden.

Nursing Reports doi: 10.3390/nursrep16100359

Authors: María José Ruiz-Castrillo Leonardo Portocarrero-Sánchez Lucía Zaballa-Pérez Alejandro Sánchez-Huertas Javier Díaz-de-Terán

Background/Objectives: Migraine is a leading cause of disability worldwide. Despite advances such as calcitonin gene-related peptide (CGRP)-targeted therapies, suboptimal treatment adherence, limited health literacy, and weak self-management remain common, and patient-reported data on the contribution of specialist headache nurses within European tertiary units are scarce. This study describes patient-reported adherence to acute treatment and to lifestyle recommendations, self-perceived knowledge, and perceived quality of life in adults with migraine who had attended a structured, nurse-led educational consultation in a tertiary multidisciplinary headache unit. Methods: This cross-sectional descriptive study included 90 adults (≥18 years) with migraine diagnosed according to the International Classification of Headache Disorders, third edition (ICHD-3), who were starting treatment with an anti-CGRP monoclonal antibody and consecutively attended a specialist nursing consultation; patients with documented cognitive impairment or without written informed consent were excluded. Between January and December 2021, participants completed, on a single occasion after the consultation, an electronic, structured, piloted ad hoc survey covering knowledge (with pre-consultation knowledge rated retrospectively), adherence to pharmacological and lifestyle recommendations, perceived changes in attack frequency and intensity, and self-reported quality of life. Data were analysed descriptively, with 95% confidence intervals (CIs) for proportions and without formal hypothesis testing. Results: Participants were mostly women (67.8%), with a mean age of 43.1 ± 10.7 years. Overall, 74.4% (95% CI 64.6–82.3) reported always following acute-treatment instructions and 66.7% (56.4–75.5) always following lifestyle recommendations; 68.9% (58.7–77.5) felt the education had improved their understanding of migraine and their quality of life, and 67.8% (57.6–76.5) perceived fewer attacks. Self-rated adequate knowledge was higher at the time of the survey than retrospectively recalled for the pre-consultation period in all five domains. The main barriers were limited prior knowledge and difficulty maintaining a headache diary. Conclusions: Most patients who had received structured nurse-led education reported good adherence and perceived benefits in their understanding of migraine and quality of life. Given the cross-sectional design, the retrospective assessment of prior knowledge, the use of a non-validated questionnaire, and the absence of a control group, these findings cannot be attributed to the consultation itself, and perceived changes in attack frequency cannot be separated from the effect of the newly started anti-CGRP treatment; prospective, controlled studies using validated outcome measures are needed. This study was not registered.

Nursing Reports doi: 10.3390/nursrep16100357

Authors: Sonia Barros Ana Carvalho Guilherme Macedo Joao C. Ferreira Miguel Mascarenhas

Background/Objectives: Artificial intelligence (AI) is increasingly integrated into clinical gastroenterology, with emerging applications in nursing contexts. However, the extent and nature of these applications in gastroenterology nursing remain under-explored. This scoping review aimed to map the current landscape of AI and closely related AI-adjacent digital technologies in gastroenterology nursing. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guideline, PubMed, Medline, Web of Science, and Scopus were searched for peer-reviewed, English-language studies published since 2000, and the findings were synthesized narratively. Results: Of 184 records identified, 11 studies were included, highlighting the potential of these technologies in clinical decision support, workflow optimization, patient education, and endoscopy assistance. Reported benefits include gains in workflow efficiency, technical accuracy, and reduced administrative workload; direct evidence of improved nursing-led patient outcomes was reported in only a minority of studies. Challenges encompass limited nurse-led research, insufficient external validation, implementation gaps, and ethical concerns. Conclusions: Greater nurse involvement in AI development is essential to drive paradigm shifts in clinical practice. This review synthesizes evidence to inform future applications, research, and policy in AI-enhanced gastroenterology nursing.

Nursing Reports doi: 10.3390/nursrep16100356

Authors: Isa C. de Jong Sylvia Gerritsen A. Laura van Melle Cornelis L. Mulder Mariëtte A. van den Hoven Yolande Voskes

Background: Managing acute psychiatric crises remains a major challenge, as some situations exceed the capacity of even specialised care. These situations typically arise from a complex interplay of patient, team, ward and organisational factors, leading to prolonged admissions, increased use of coercive measures, and distress for both patients and professionals. Aims: This study aimed to identify the most challenging situations within High and Intensive Care wards, clarify their multifactorial origins, and explore strategies for more effective management. Method: This multi-centre, multi-method sequential qualitative study involved two phases: collecting 40 challenging cases, synthesized into two fictional vignettes, and discussing these in three focus groups with 33 mental health professionals, with data analysed through qualitative content and thematic analysis. Results: Participants recognised the vignettes and emphasised that it is the combination of patient, team, ward and system factors that places teams under sustained pressure, undermining the therapeutic environment and safety. These situations often evoke strong emotional responses and certain team dynamics, such as countertransference and splitting. Key challenges included dilemmas around admission, lack of treatment perspective, and systemic barriers. Suggested strategies focused on reward-based and autonomy-promoting care, requiring improved team communication, decisive clinical decision-making, and shared responsibility with external partners. Conclusions: Addressing challenging situations in High and Intensive Care wards calls for timely recognition, open discussion, structured team reflection, and ongoing staff training. Personalised care, clear protocols, and robust cross-sector collaboration are essential. Ongoing evaluation and further research, including patient and network partner perspectives, are needed to optimize interventions and ensure effective, empathic care.

Nursing Reports doi: 10.3390/nursrep16100355

Authors: Yasue Yamazumi Mina Sakurai Rika Matsumoto

Background/Objectives: Decent Work (DW) has emerged as a comprehensive framework for understanding the quality of working conditions. However, evidence regarding DW among hospital nurses remains limited, particularly in Japanese hospitals with 200–399 beds. This study aimed to describe DW among hospital nurses working in hospitals with 200–399 beds in Japan and to examine its associations with work engagement, burnout, and job crafting. The five-factor structure of the Decent Work Scale for Hospital Nurses (DWS-N) was also re-examined in an independent sample. Methods: A cross-sectional, web-based survey was conducted among hospital nurses working in Japanese hospitals with 200–399 beds between 7 July and 2 August 2026. Of 348 responses received, 342 were included in the analysis. Participants completed the DWS-N, the Utrecht Work Engagement Scale, the Copenhagen Burnout Inventory, and the Job Crafting Scale. Descriptive statistics, confirmatory factor analysis (CFA), correlation analyses, and hierarchical multiple regression analyses were performed. The regression analyses examined associations between the five DWS-N dimensions and the study outcomes after adjustment for age and sex. Results: The mean DW score was 72.64 (SD = 13.97). The previously established five-factor DWS-N model showed acceptable approximate fit (CFI = 0.939, TLI = 0.929, RMSEA = 0.063). Total DW was positively correlated with work engagement (r = 0.550, p < 0.001) and all four job crafting dimensions (rs = 0.218–0.294, all p < 0.001), and negatively correlated with all three burnout dimensions (rs = −0.476 to −0.528, all p < 0.001). In adjusted regression analyses, Meaningful and Fulfilling Work was positively associated with work engagement and with three of the four job crafting dimensions and negatively associated with all three burnout dimensions. Supportive and Safe Working Environment was positively associated with work engagement and selected job crafting dimensions and negatively associated with client-related burnout. Appropriate Working Time and Work–Life Balance was negatively associated with personal and work-related burnout and positively associated with decreasing hindering job demands. Protection of Workers’ Rights showed negative adjusted associations with three job crafting dimensions. Conclusions: DW was associated with work engagement, burnout, and job crafting among hospital nurses working in Japanese hospitals with 200–399 beds. The dimension-specific findings suggest that different aspects of DW may show distinct associations with nurses’ psychological and proactive work-related outcomes. Given the cross-sectional design, these findings should be interpreted as associations rather than temporal or causal relationships. Longitudinal research is needed to examine the direction and temporal ordering of these relationships.

Nursing Reports doi: 10.3390/nursrep16100354

Authors: Guglielmo Imbriaco Nino Fijačko Sergio Cazorla-Calderón Kristin Alm-Kruse Marco Mion

Bystanders, lay rescuers, and close ones involved in out-of-hospital cardiac arrest resuscitation attempts that end in death represent an often-overlooked population within emergency care. As community-centered resuscitation systems increasingly promote dispatcher-assisted cardiopulmonary resuscitation (CPR), community first responder programs, and public CPR training, more individuals are becoming directly involved in resuscitation attempts, many of which are unsuccessful. Such experiences can be associated with emotional distress, intrusive memories, guilt, and post-traumatic stress symptoms. The impact may differ according to the person’s relationship with the patient and their involvement in the resuscitation. This perspective paper discusses the psychological impact of unsuccessful resuscitation and considers the role of emergency nurses in providing support across dispatch, prehospital, and hospital settings. Approaches such as supportive follow-up contact and referral for psychological support, as distinct from formal psychological debriefing protocols, could help address some of these needs, although current evidence on their effectiveness remains preliminary. Greater recognition of people involved in unsuccessful resuscitation and their support needs may represent a further step in the development of community-centered resuscitation systems.

Nursing Reports doi: 10.3390/nursrep16100353

Authors: Khalil A. Saleh Naif Taleb Ali Abdulhafith Alharbi

Background: Yemen’s long-standing armed conflict has decimated the health system and subjected nurses to unprecedented levels of occupational and conflict-related stress. The role of nurses is pivotal, yet little is known about their mental health in Yemen, limiting the evidence available to inform nursing leadership and workforce protection strategies. Methods: A multicenter cross-sectional study was carried out between January and December 2025, involving 800 registered nurses from 24 health facilities across eight conflict-affected Yemeni governorates using a multistage sampling strategy with probability-based selection of facilities and nurses within accessible governorates. Validated Arabic PHQ-9 and GAD-7 questionnaires (cut-off ≥ 10) were used to assess depression and anxiety. Burnout was assessed using a single-item self-rated measure with pilot validation against the Maslach Burnout Inventory emotional exhaustion subscale (r = 0.82), selected for pragmatic feasibility in a highly stressed population. Mixed-effects logistic regression was used to account for clustering at the facility level. Exploratory supplementary analyses examined associations involving self-rated burnout and reported availability of psychological support. Results: 52.0% (95% CI: 48.5–55.5) of nurses experienced moderate-to-severe depressive symptoms, while 47.0% (95% CI: 43.5–50.5) experienced moderate-to-severe anxiety symptoms. High self-rated burnout was prevalent in 34.0% (95% CI: 30.7–37.4), and 54.8% (95% CI: 51.2–58.3) reported their intention to leave within 12 months. Psychological distress was independently associated with displacement (AOR = 2.31, 95% CI: 1.68–3.17), workplace violence (AOR = 2.84, 95% CI: 2.03–3.97), inadequate income (AOR = 2.53, 95% CI: 1.80–3.56), nurse-to-patient ratios ≥ 1:20 (AOR = 1.68, 95% CI: 1.07–2.63), and frequent night shifts (AOR = 1.26, 95% CI: 1.17–1.36 per additional shift). Not all expected associations were significant; nurse-to-patient ratios of 1:15, facility type, and type of employment showed no consistent associations. Sampling-weighted prevalence estimates were very similar to the unweighted estimates (absolute differences < 1 percentage point), supporting the robustness of the findings against differential selection probabilities across governorates. Conclusions: Armed conflict and structural workforce stressors were associated with a substantial mental health burden among nurses in southern, central, and eastern governorates in Yemen. Because the most heavily conflict-affected northern governorates were inaccessible for security reasons, the findings are generalizable only to accessible areas, and the direction of difference in burden in inaccessible areas cannot be determined from these data. While the cross-sectional design precludes causal inference, the findings identify potential targets for intervention. Mental health support, workplace violence prevention, and safe staffing in nursing leadership and humanitarian workforce strategies may be relevant to workforce resilience strategies in fragile health systems, but these are implications consistent with observed associations rather than evidence of intervention effectiveness. Findings should be interpreted given the cross-sectional design, limited geographical access, and the use of a single-item self-rated burnout measure that does not capture the multidimensional nature of burnout. Future longitudinal studies should include multidimensional burnout instruments and trauma-related assessment.

Nursing Reports doi: 10.3390/nursrep16100352

Authors: Jackie Hoi Man Chan Khalil Yousef Ibrahim Alananzeh Sarah Hatahet

Background/Objectives: Generative artificial intelligence (GenAI) presents immense potential to advance the flipped learning approach. Yet, it is under-explored. This study presents the postgraduate nursing students’ experience in using GenAI when learning nursing leadership, guided by Bloom’s taxonomy, in a flipped-learning approach. Methods: A descriptive qualitative design was employed, and individual semi-structured interviews were conducted with nine postgraduate nursing students who had completed a nursing leadership course delivered via a GenAI-integrated flipped-learning approach. Results: Three interconnected themes emerged: (1) GenAI supplements in-person learning, (2) Direct and Socratic questioning, and (3) Factors contributing to the GenAI learning experience. Students appreciated that GenAI helped them summarize and understand the learning material, thereby promoting meaningful in-class activities. Students highlighted direct and Socratic questioning as the major approaches in using GenAI and reported their perceived strengths and weaknesses. Notably, Socratic questioning—AI-driven thought-provoking dialog—was perceived to have helped develop critical thinking and promote deep learning. However, suboptimal prompting technique was the barrier, while channels for learning prompting and integrating it into the curriculum were facilitators. Conclusions: This study reveals an overall positive experience with the use of GenAI in flipped learning in postgraduate nursing education.

Nursing Reports doi: 10.3390/nursrep16100351

Authors: Merilyn Guerra-Ramírez María Moreno-Fergusson

Pregnancy intention is widely used in sexual and reproductive health research and practice, yet its conceptual boundaries remain insufficiently defined. This imprecision limits consistent interpretation and shapes how nurses and other health professionals assess and support women’s reproductive decision-making across the reproductive continuum. Objective: to clarify the concept of pregnancy intention and to propose a conceptual definition applicable to nursing practice, sexual and reproductive health care, and health promotion. Methods: A concept analysis was conducted using Walker and Avant’s eight-step method. A structured search of the literature published between 2014 and 2025 in English, Spanish, and Portuguese was carried out in PubMed, Web of Science, SAGE, ScienceDirect, SciELO, and Dimensions, complemented by lexicographic sources and grey literature. Data were extracted and analyzed to identify the concept’s uses, defining attributes, antecedents, consequences, and empirical referents. Results: Pregnancy intention emerged as a multidimensional concept defined by three attributes: temporal orientation toward a future pregnancy, conscious deliberation about conceiving, and contextual appraisal of readiness. It is defined as a woman’s conscious and prospective disposition toward a future pregnancy, involving deliberation about conceiving and contextual appraisal of her readiness in relation to the personal, relational, socioeconomic, and health-related circumstances she considers relevant to the decision. Conclusions: The proposed definition provides a theoretically coherent basis for reproductive assessment, preconception care, and woman-centered health promotion. By recognizing the personal, social, and structural conditions relevant to women’s health, including socioeconomic conditions that may contribute to broader social determinants of health, it also supports a health-equity perspective and provides a basis for future prospective measurement that reflects women’s reproductive experiences.

Nursing Reports doi: 10.3390/nursrep16100350

Authors: Blerina Duka Michele Biring-Pani Fabiola Mane Jola Çini Armela Zylfo Kujtime Vakeflliu Ippolito Notarnicola

Background/Objectives: Telemedicine has substantial potential to improve access and continuity of care, but implementation depends on professional, organizational, technological, and governance readiness. This cross-sectional study examined healthcare professionals’ perceptions of telemedicine implementation in Albania as an exploratory needs-assessment phase informed by Living Lab principles. Methods: An online survey was completed by 1213 healthcare professionals. The study used a questionnaire developed for this project; its multi-item domains are therefore treated as exploratory rather than established constructs. Descriptive statistics, exploratory factor analysis, Spearman correlations, and multivariable linear and logistic regression were used. Two supplementary open-ended questions were analyzed using content-oriented thematic coding and integrated with the structured survey findings to identify preliminary priorities for later participatory co-design. Results: High future willingness to use telemedicine was reported by 67.4% of participants. Continuous training (84.7%), adaptation of traditional healthcare delivery (65.8%), limited digital skills (64.7%), and lack of clear protocols/guidelines (61.5%) were frequently endorsed implementation issues. Perceived usefulness showed the strongest adjusted statistical association with future willingness in the linear model (B = 0.665, 95% CI 0.602–0.727, p < 0.001) and logistic sensitivity model (OR = 5.41, 95% CI 4.32–6.79, p < 0.001). Professional confidence was positively associated with willingness, whereas workflow and relational barriers were negatively associated. Conclusions: The findings describe the perceptions of this non-probability sample and should not be interpreted as national estimates of telemedicine readiness. They provide exploratory evidence that may inform subsequent stakeholder consultation, instrument validation, and participatory Living Lab activities focused on training, workflow integration, infrastructure, governance, and patient engagement.

Nursing Reports doi: 10.3390/nursrep16100349

Authors: Laura Hynes Sabine Pangerl Phoebe George Richard Gray Lauren Blekkenhorst Irene Ngune Asan Akpan Michael Hunter Rosemary Saunders Martin Jones

Background/Objectives: Chronic non-cancer pain is a complex and highly prevalent condition that can cause significant physical, psychological, and social burdens on individuals and families, while placing increasing strain on health systems. This study aims to map and compare the perspectives of key stakeholders on the barriers, facilitators, and practical considerations relevant to the potential future development of a volunteer-delivered Behavioural Activation model of care for older adults living with chronic non-cancer pain in regional communities. Methods: Using Trochim’s structured concept mapping methodology, this mixed-methods, participatory study engages participants from three stakeholder groups: older adults with lived experience of chronic non-cancer pain, community (lay) volunteers and health professionals. Approximately 20–30 participants will be recruited, with around 7–10 participants from each stakeholder group, using community and professional networks, local referrals, and social media. Recruitment will remain flexible to support balanced representation across groups. Concept mapping will be used to compare perspectives on barriers, facilitators and implementation considerations relevant to a future volunteer-delivered model of care. The methodology comprises six stages: preparation, generation of statements, structuring of statements, representation, interpretation and utilisation. Conclusions and Expected Results: By exploring stakeholder perspectives, this study will identify priorities, barriers, facilitators and implementation considerations for community volunteer involvement in low-intensity psychosocial support. Findings may inform the development of future volunteer-delivered models and subsequent intervention and implementation studies, including structured training pathways and potential micro-credentialing for community volunteers in regional and rural settings. This study was retrospectively registered with the Open Science Framework Registries on 30 June 2026, following commencement of data collection for the brainstorming phase but prior to completion of the subsequent sorting, rating, representation and interpretation phases and prior to formal data analysis.

Nursing Reports doi: 10.3390/nursrep16100348

Authors: Sofia Silva Isabel Quelhas Esperança Gago

Background/Objectives: The first hospital discharge during childhood cancer treatment marks a transition from continuous professional monitoring to greater parental responsibility at home. This study aimed to explore parents’ experiences of this hospital-to-home transition and how they sought to establish safety while assuming responsibility for care. Methods: This qualitative study presents a focused analysis of data from a broader grounded theory study conducted according to Corbin and Strauss at a single specialised paediatric oncology centre in Portugal. The broader study included 16 parents recruited through theoretical sampling; the present analysis included 14 participants whose interviews provided substantive accounts of the discharge transition relevant to this analytical category. Data were generated through open interviews and analysed using constant comparison and progressive category development. Results: The first hospital discharge was characterised by relief and renewed family connection alongside uncertainty, perceived vulnerability, and fear of clinical deterioration. Parents sought to construct safety at home through vigilance, environmental adaptation, preventive practices, organisation of complex care, and mobilisation of professional and informal support. Four interrelated subcategories were identified: transitioning beyond professional monitoring, establishing safety at home, assuming responsibility for complex care, and protecting the child while sustaining family life. Conclusions: Safety following discharge was not simply restored by returning home but progressively constructed through parental action, learning, and adaptation. Nursing support should extend beyond technical discharge instruction to include progressive preparation, assessment of parental readiness, development of caregiving competence, accessible nursing guidance, multidisciplinary support, and attention to family conditions influencing sustainable care at home. This study was not registered.

Nursing Reports doi: 10.3390/nursrep16100347

Authors: Haejung Lee DaeEun Lee

Purpose: This study aimed to examine differences in sociodemographic characteristics, self-efficacy, and health-related factors across the stages of change for physical activity and dietary management among patients with metabolic syndrome (MetS). Methods: This secondary analysis included 208 adults aged 40–<70 with MetS who were recruited from a university hospital in South Korea. Participants had either a history of cardiovascular disease (CVD) or an intermediate-to-high 10-year CVD risk. Data were analyzed using descriptive statistics, chi-square test or Fisher’s exact test, Mann–Whitney U test, and Kruskal–Wallis test. Statistical analyses were performed using SPSS version 22.0 and RStudio version 2026.08.1. Results: Across the stages of change for physical activity, significant differences were observed in age, healthy diet, self-care, and current smoking status. Across the stages of change for dietary management, significant differences were observed in healthy diet and self-care. When participants were classified into no-action, single-action, and double-action groups based on their stages of change for physical activity and dietary management, significant differences were found in age, employment status, healthy diet, self-care, and current smoking status. Conclusions: These findings suggest that interventions for patients with MetS should be tailored to their stages of change and health-related characteristics. In particular, interventions that address both physical activity and dietary management and strengthen collaborative relationships with healthcare providers may help promote health behavior change in this population.

Nursing Reports doi: 10.3390/nursrep16100346

Authors: Telma Quaresma Maria Céu Marques Liliana Mota

Background: Healthcare systems worldwide are facing an unprecedented nursing workforce crisis driven by staff shortages, population ageing, increasing care complexity, and difficulties in retaining qualified professionals. Although talent management has emerged as a strategic organisational approach to address these challenges, its application within hospital nursing remains fragmented and has not yet been systematically synthesised. Objective: To map the available scientific evidence on organisational approaches to talent management in hospital nursing. Methods: A scoping review was conducted following the Joanna Briggs Institute methodology and reported according to the PRISMA-ScR guidelines. A comprehensive search was performed on 20 February 2026 across MEDLINE, CINAHL® Plus with Full Text, Nursing & Allied Health Collection, MedicLatina, CENTRAL, CDSR, LILACS, SciELO, RCAAP, and additional grey literature sources. Eligibility criteria were established using the Population–Concept–Context (PCC) framework. Study selection and data extraction were independently conducted by two reviewers. Results: From 8534 records identified, 11 eligible records representing 10 independent studies were included. Four core Talent Management processes were identified: talent identification, development, retention and evaluation. The interpretative synthesis further distinguished organisational antecedents, including participative leadership, development-oriented cultures, professional recognition and academic–practice partnerships; relational and motivational mechanisms, including work engagement, psychological contract fulfilment and social capital; and workforce and organisational outcomes, particularly retention intention, leadership development and organisational commitment. These findings informed the development of an integrated conceptual framework for Talent Management in hospital nursing. Conclusions: The available evidence suggests that Talent Management may be more appropriately conceptualised as an integrated organisational capability rather than as a set of isolated human resource practices. This review provides an integrated mapping of the available evidence on Talent Management models specifically focused on hospital nursing, offering a conceptual foundation to support future research, organisational strategies and model development.

Nursing Reports doi: 10.3390/nursrep16100345

Authors: Melynn Grace Parcon Sara Darias-Curvo Cristo Manuel Marrero-González Ángel Ramón Sabando-García

Background: In the Philippines, despite recent health system reforms, barriers to healthcare access and financial protection persist, and the role of parental migration in shaping healthcare access among university students remains incompletely understood. Guided by the Social Determinants of Health framework and Andersen’s Behavioral Model of Health Services Use, this study aimed to describe health and healthcare-related experiences in a sample of university students in Cavite; compare self-reported mental-health-related experiences by current parental overseas employment; and explore bivariate associations between selected student characteristics and self-reported health-insurance status. Methods: A cross-sectional survey of 485 university students aged 18–25 was conducted between June and July 2023 in Cavite, Philippines. Conventional statistical analyses were used to describe the sample and assess unadjusted associations between selected variables. Results: Most students reported no health insurance (74.2%), and preventive healthcare engagement was low. 11.3% had parental migration experience. No consistent overall pattern of statistically significant differences was observed between students with and without parental migration experience across the self-reported mental-health-related experiences examined. Conclusions: Self-reported mental-health-related experiences were common among participating students. Although no consistent overall differences were identified according to parental migration experience, the findings suggest that self-reported mental-health-related experiences may be shaped by interacting academic, socioeconomic, and familial factors. Low perceived insurance coverage and limited preventive healthcare engagement highlight persistent barriers to healthcare access. Strengthening university-based mental health services, health literacy initiatives, and preventive healthcare engagement remains essential.

Nursing Reports doi: 10.3390/nursrep16090344

Authors: Joshua Kanaabi Muliira Eilean Rathinasamy Lazarus

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.

Nursing Reports doi: 10.3390/nursrep16090343

Authors: Telma Quaresma Maria Céu Marques Liliana Mota

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.

Nursing Reports doi: 10.3390/nursrep16090342

Authors: Nabat Almalki Atheer Asiri Lama Alkhaldi Huda Majrashi Abeer Almotairi Amal Alfifi Hind Althobaiti Badriah Althubaiti Jawharah Alhufayyan Bushra Alshammari Mawahib Almalki

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.

Nursing Reports doi: 10.3390/nursrep16090341

Authors: Martina Feliu Maria Gallo-Fernández Adrián Bouzas Maria Isabel Buceta-Toro Clara Gomez-Urios

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.

Nursing Reports doi: 10.3390/nursrep16090340

Authors: Signe Eekholm Marie-Louise Strandberg Line Risberg Hartvigsen Julie Grubbe Silvia Loua Henriksen Dorthe Bauer Sidse Breer Schultz Volden Camilla Elmig Feuerlein Ingrid Poulsen

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.

Nursing Reports doi: 10.3390/nursrep16090339

Authors: José Júlio Veríssimo Júlio Belo Fernandes

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.

Nursing Reports doi: 10.3390/nursrep16090338

Authors: Ivana Finiguerra Maria Michela Gianino Roberta Vacchelli Marco Demasi Lusi Pappalardo Chiara Albanese Elisa Binello Giulia Borghin Serena Cappello Nadia Cavagnini Serena Durante Alice Ferraris Fabiana Gorgonzola Barbara Munaro Stefania Pellegrino Clara Russo Laura Tedino Davide Minniti Salvatore Di Gioia

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.

Nursing Reports doi: 10.3390/nursrep16090337

Authors: Zaida Santana-Casiano Claudio-Alberto Rodríguez-Suárez Sergio Mies-Padilla Milagros de la Rosa-Hormiga Candelaria de la Merced Díaz-González Héctor González-de la Torre

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.

Nursing Reports doi: 10.3390/nursrep16090336

Authors: Marin Mamić Nikolina Farčić Ivana Barać Željko Mudri Marija Barišić Ivana Mamić Zrinka Puharić Gabriela Katharina Pomper Ivan Vukoja

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.

Nursing Reports doi: 10.3390/nursrep16090335

Authors: Eleonora Lombardi Gianluca Barra Davide Vicari Luciano Midolo Floriana Pinto Francesco Limonti Roberta Decaro Francesca Trotta Davide Bartoli

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.

Nursing Reports doi: 10.3390/nursrep16090334

Authors: Sang Un Park So Young Choi

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.

Nursing Reports doi: 10.3390/nursrep16090333

Authors: Juan Alberto Sanchis-Gimeno Andreea-Bianca Zuld Jose E. León-Rojas Juan José Valenzuela-Fuenzalida Alejandro Bruna-Mejías Gustavo Oyanedel-Amaro Mathias Orellana-Donoso

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.

Nursing Reports doi: 10.3390/nursrep16090332

Authors: Cristina Álvarez-García Cesar Ivan Aviles-Gonzalez Sebastián Sanz-Martos Carmen Álvarez-Nieto Isabel M. López-Medina Sergio Martínez-Vázquez Maria Dolores López-Medina Eva M. Montoro-Ramirez

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.

Nursing Reports doi: 10.3390/nursrep16090331

Authors: Noelia Navamuel-Castillo Josep-Oriol Casanovas-Marsal Ángel Boned-Galán Ana Belén Hernández-Ruiz Nieves López-Ibort Ana Gascón-Catalán

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.

Nursing Reports doi: 10.3390/nursrep16090330

Authors: Sally C. Stearns Jane A. Weintraub John S. Preisser Kimberly T. Ward Christopher J. Wretman Philip D. Sloane Sheryl Zimmerman

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).

Nursing Reports doi: 10.3390/nursrep16090329

Authors: Janet Froulund Jensen Liv Gølnitz Hjorhöy Belle Mia Ingerslev Loft

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.

Nursing Reports doi: 10.3390/nursrep16090328

Authors: Matías Fuentealba-Márquez David Prieto-Merino Miguel Ángel López-Espinoza

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.

Nursing Reports doi: 10.3390/nursrep16090327

Authors: Artemisia Kokkinari Evangelia Antoniou Dimitrios Iatrakis Anastasia Bothou Athina Diamanti Evangelia Leontitsi Maria Dagla

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.

Nursing Reports doi: 10.3390/nursrep16090326

Authors: Fatma Magdi Ibrahim

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.

Nursing Reports doi: 10.3390/nursrep16090325

Authors: Cátia Sofia Marques Teixeira Amélia Filomena Oliveira Mendes Castilho Andréa Ascenção Marques

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.

Nursing Reports doi: 10.3390/nursrep16090323

Authors: Joana Pereira Sousa Paulo Santos-Costa João Graveto Paulo Ferreira Maria Loureiro

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.

Nursing Reports doi: 10.3390/nursrep16090324

Authors: Wakako Yachi

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.

Nursing Reports doi: 10.3390/nursrep16090322

Authors: Ayano Ando Runa Tokunaga Takahiro Mihara Makoto Kaneko

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.

Nursing Reports doi: 10.3390/nursrep16090320

Authors: Kyoko Osaka Kaito Onishi Krishan Soriano Tetsuya Tanioka Misao Miyagawa Masashi Akaike Yasuhiko Nishioka Minoru Irahara Rick Yiu Cho Kwan Gochoosuren Gankhuyag Tsogbadrakh Basbish Taivan Enkhzaya Otgonbayar Uulensolongo Enkh-Amgalan Bat-Ulzii Galmandakh Lkhamaa Luvsan Munkh-Erdene Purevdorj Bayasgalan Badamdorj Oyungoo Boldbaatar Damdindorj

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.

Nursing Reports doi: 10.3390/nursrep16090321

Authors: Mattia Bozzetti Ilaria Marcomini Roberta Pendoni Alberto Silla Miriam Mariani Gianmario Pedretti Alessio Conti Alessio Lo Cascio Greta Ghizzardi Daniele Napolitano

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.

Nursing Reports doi: 10.3390/nursrep16090319

Authors: Montserrat Puig-Llobet Sara Sanchez-Balcells Zaida Agüera Maria Aurelia Sánchez-Ortega Ana Ventosa-Ruiz Khadija El-Abidi Núria Vergés Bosch Dolors Rodriguez-Martin Nuria Rodríguez Ávila Alba Juárez Sánchez Elena Maestre Mireia Perau Campos Alba Luque Cristina Martínez Bueno Liliana Aragón Castro Cristina Esteban Sanz Marina Nebot Echeverria Assumpta Rigol Marta Prats-Arimon

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.

Nursing Reports doi: 10.3390/nursrep16090318

Authors: Erica Blumenstock Debra Penrod Heather Brown

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.

Nursing Reports doi: 10.3390/nursrep16090317

Authors: Chen-Jin Liao Su-Er Guo Ming-Ju Hsieh Li-Fen Chao

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.

Nursing Reports doi: 10.3390/nursrep16090316

Authors: Domonkos Tinka Mohammad Milad Shafaie

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.

Nursing Reports doi: 10.3390/nursrep16090315

Authors: Tao Wang Jing-Yu (Benjamin) Tan Mengyuan Li Haiying (Emily) Wang Sita Sharma Daniel Terry

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.

Nursing Reports doi: 10.3390/nursrep16090314

Authors: Eman Ramadan Abdalfadeel Eman Kamel Hossny Ahmed Zinhom Elkady Mohannad Aldiqs

Background: Entrepreneurship has become an essential competency for healthcare professionals because it promotes innovation, autonomy, and the development of sustainable healthcare services. Although entrepreneurship education has demonstrated positive effects on students’ entrepreneurial knowledge and competencies, evidence regarding its effectiveness among nursing interns remains limited. This study examined changes in nursing interns’ entrepreneurship awareness, entrepreneurial intention, and entrepreneurial characteristics following participation in a structured entrepreneurship training program. Methods: A quasi-experimental one-group pretest–posttest design with a two-month follow-up assessment was conducted among 168 nursing interns at the Faculty of Nursing, Cairo University. Participants completed three researcher-developed instruments assessing entrepreneurship awareness, entrepreneurial intention, and entrepreneurial characteristics. The intervention consisted of a structured entrepreneurship training program delivered through interactive educational strategies, including lectures, group discussions, brainstorming, case-based learning, and practical activities. Data were analyzed using repeated-measures analysis of variance (ANOVA) and Pearson correlation coefficients. Bonferroni-corrected pairwise comparisons were performed following significant overall repeated-measures effects. Results: Entrepreneurship awareness increased significantly across the three assessment periods, with scores increasing from 6.41 ± 3.16 at baseline to 16.99 ± 3.45 immediately after the intervention and remaining significantly higher at the two-month follow-up (14.42 ± 4.01; p < 0.001). Significant improvements were also observed in overall entrepreneurial characteristics (F = 158.08, p < 0.001, ηp2 = 0.49), particularly perseverance, demand for efficiency and quality, commitment to work, information seeking, goal setting, and planning. In contrast, entrepreneurial intention did not change significantly across the three assessment periods (F = 1.22, p = 0.30, ηp2 = 0.01). Entrepreneurship awareness was weakly and positively correlated with entrepreneurial intention across the assessment periods (r = 0.165–0.263, p < 0.05). Conclusions: Participation in the entrepreneurship training program was associated with significant improvements in entrepreneurship awareness and entrepreneurial characteristics among nursing interns, whereas entrepreneurial intention did not demonstrate a statistically significant change. Integrating entrepreneurship education into undergraduate nursing curricula may strengthen innovation-related competencies and prepare future nurses to develop sustainable healthcare initiatives. Future controlled longitudinal studies should investigate the psychological and contextual factors that may influence the development of entrepreneurial intention.

Nursing Reports doi: 10.3390/nursrep16090313

Authors: Jun Okuda Yoshiyuki Takashima

Background/Objectives: Nurses may support offense-related self-reflection through practices that extend beyond formal group programs and dedicated offense-focused interviews; however, the scope of such support remains unclear. In this study, we described the range of nursing practices that nurses in Japanese forensic psychiatric inpatient settings perceived as supporting offense-related self-reflection beyond these formal interventions. Methods: A qualitative descriptive study was conducted using individual semi-structured interviews with 13 nurses from six hospitals between May and November 2025. Japanese-language transcripts were analyzed using inductive qualitative content analysis. Meaning units were coded and iteratively organized into subcategories and categories. Credibility and dependability were strengthened through co-researcher review, reflexive discussion, audit trail, and peer debriefing. Results: Five categories and 15 subcategories were identified: (1) examining offenses, victim impact, and responsibility; (2) clinical and relational readiness for self-reflection; (3) applying reflective insights to recidivism-prevention actions; (4) extending reflective learning into post-discharge life planning; and (5) integrating offense-related understanding into inpatient–community care planning. Conclusions: The categories describe functions that participants attributed to nursing practices surrounding formal interventions; therefore, they should not be interpreted as validated components of self-reflection or as evidence of effectiveness. The findings provide an initial, context-specific framework to guide nursing assessment, care planning, education, and further conceptual and empirical research that includes patients and community providers.

Nursing Reports doi: 10.3390/nursrep16090312

Authors: Paulo Cruchinho Gisela Teixeira Pedro Lucas Filomena Gaspar María Dolores López-Franco

Background: Missed Nursing Care is a comprehensive, multidimensional, and frequently occurring phenomenon in various clinical contexts in Portugal. Objective: This study aimed to translate, adapt, and cross-culturally validate the MISSCARE Survey-Patient for the Portuguese population and to analyze the quality of its measurement properties. Methods: An exploratory–descriptive, quantitative, cross-sectional validation study was conducted. The questionnaire underwent cross-cultural adaptation through translation, translation synthesis, and back-translation procedures, followed by harmonization by an expert committee, pre-testing, and field testing. Results: Ten hospitalized persons and ten nurses participated in the pre-test as experts, while 135 hospitalized persons were included in the field testing. In the pre-testing, excellent content validity indices were obtained for clarity (S-CVUI/Med of 0.98 and S-CVI/UA of 0.84) and cultural relevance (S-CVUI/Med and S-CVI/UA of 1.00) for the overall instrument. In the field testing, a final three-dimensional model (Basic Care, Communication, and Time to Response) was obtained, explaining 66.7% of the total variance. Evidence based on internal structure was supported by Structural Validity indices from the confirmatory factor analysis [X2(56) = 52.421, p < 0.001, χ2/df = 2.722; PCFI = 0.640 and CFI = 0.892]. Convergent Validity was demonstrated through a moderate correlation between the instrument and a question assessing satisfaction with care (r = −0.677; p < 0.001). For the overall instrument, Cronbach’s α was 0.818, indicating very good Internal Consistency, while values for the dimensions ranged between 0.766 and 0.902. Minimal Important Change exceeded the Smallest Detectable Change by seven points for the total instrument, suggesting good potential to detect meaningful changes. Conclusions: The MISSCARE Survey-Patient-PT demonstrates good measurement properties for assessing hospitalized patients’ perceptions of the occurrence of Missed Nursing Care in Portuguese health services.

Nursing Reports doi: 10.3390/nursrep16090311

Authors: Helena José Martina Giusti Lara Costa e Silva Diogo João Tomás Susana Ganhão-Arranhado Carla Silva Luís Manuel Mota de Sousa

Background/Objectives: This study aimed to identify and categorise the educational, training, and support needs of informal caregivers of stroke survivors in order to inform the development of an Immersive Virtual Reality (IVR) intervention within the European caregIVR project (Project No. 101129454; EU4Health Programme). Methods: A qualitative descriptive study was conducted using three focus groups involving informal caregivers, healthcare professionals and other stakeholders, and academics and healthcare students in Portugal (n = 33). Discussions explored everyday caregiving challenges, priority educational needs, and expectations regarding digital support tools. Data were analysed using qualitative content analysis with an inductive–deductive coding strategy supported by NVivo software (version 14). Results: Participants identified the transition from hospital to home as the most critical stage of the caregiving journey, characterised by poor continuity of care and insufficient preparation before hospital discharge. Major challenges included limited stroke-related health literacy, difficulties adapting the home environment, and substantial emotional, financial, and social burdens that frequently resulted in social isolation and caregiver burnout. Participants regarded IVR as a promising educational strategy for delivering practical, repetitive, and low-risk skills training. Conclusions: The findings suggest that caregiver empowerment should be promoted through progressive, person-centred, and non-judgemental educational programmes tailored to caregivers’ evolving needs. Caregivers should be supported by multidisciplinary teams capable of addressing the clinical, practical, and psychosocial complexity of post-stroke home care. Rather than replacing professional support, IVR should be considered a complementary educational tool with the potential to improve caregivers’ preparedness, confidence, and safety in the home-care setting.

Nursing Reports doi: 10.3390/nursrep16090310

Authors: Ana Fernandez-Alonso Victoria Mateo-Frances Lucia Noguerales-Fuertes Alejandra Jover-Walsh Juan Sebastian Arana-Arce Paula Cubillo-Heras Victor Fernandez-Alonso

Background/Objectives: Anaphylaxis is a severe systemic allergic reaction that may involve multiple organ systems and requires prompt recognition and treatment. In children and adolescents, food is a major trigger, and clinical presentation may vary according to biological factors, including sex. This study aimed to examine sex-related differences in the clinical presentation, triage acuity, measured emergency-care processes, and suspected triggers of anaphylaxis in pediatric patients treated at a tertiary hospital. Methods: A retrospective cross-sectional study was conducted in the pediatric emergency department of a tertiary hospital in Madrid, Spain, between 2015 and 2022. Sociodemographic characteristics, allergic history, clinical manifestations, TRIPED-GM triage level, Pediatric Assessment Triangle classification, measured emergency-care processes, suspected triggers, hospital admission, and final diagnosis were analyzed. Multiple comparisons were controlled using Bonferroni adjustment within clinically defined domains. Results: A total of 368 patients were included; 65.2% were boys and 57.3% were aged ≤5 years. Unadjusted analyses identified several apparent signals in specific clinical manifestations, triage distribution, and suspected triggers; none showed a consistent pattern after multiplicity adjustment. The difference in the overall distribution of TRIPED-GM triage levels was not statistically significant after multiplicity adjustment. Although Grade 3 assignment remained more frequent among boys in a category-specific post hoc analysis, this isolated finding was not supported by multivariable ordinal regression, in which sex was not independently associated with overall triage acuity. Tree nuts, cow’s milk protein, and egg were the most frequently suspected triggers. Conclusions: No consistent evidence of overall sex-related differences in suspected pediatric anaphylaxis presentation, measured emergency-care processes, suspected triggers, or triage acuity was found after multiplicity adjustment and multivariable analysis. Although an isolated difference in Grade 3 triage assignment persisted in a post hoc analysis, it should be interpreted cautiously. Pediatric emergency nursing assessment and triage should therefore remain primarily guided by acute clinical presentation and physiological severity rather than by sex. Larger multicenter studies are needed to determine whether more subtle or age-dependent sex-related patterns have clinical relevance.

Nursing Reports doi: 10.3390/nursrep16090309

Authors: Zhe-Ning Yu Tai-Chu Peng

Background/Objectives: Nurses in Taiwan faced markedly increased nurse-to-patient ratios and a high risk of occupational infection during the COVID-19 pandemic, generating considerable psychological and social strain. Professional commitment—reflecting nurses’ identification with, investment in, and intention to remain in the profession—is important for workforce retention and care quality, yet little is known about how contracting COVID-19 affects it. This study examined whether COVID-19 infection and the presence of long COVID symptoms were associated with professional commitment among clinical nurses, and identified sociodemographic, work-stress, and social-support correlates of commitment. Methods: A cross-sectional survey was conducted among registered nurses at a medical center in eastern Taiwan between 21 September 2023 and 28 February 2024. An anonymous electronic questionnaire assessed sociodemographic characteristics, COVID-19 infection/long-COVID status, work stress (Stress Scale for Healthcare Workers Caring for Patients with High-Risk Infectious Diseases), social support (Social Support Scale for clinical nurses), and professional commitment (Hospital Nurses’ Job Satisfaction and Professional Commitment Scale). Data from 364 valid responses (response rate 39.8% of the 914 nurses employed at the study hospital) were analyzed using independent-sample t-tests, Pearson correlation, one-way ANOVA, and multiple linear regression. Results: Professional commitment did not differ significantly by COVID-19 infection status (t = 0.50, p = 0.619) or by presence of long COVID symptoms (t = 0.85, p = 0.397). Social support was positively correlated with professional commitment (r = 0.261, p < 0.001), as was work stress, although the latter association was weak (r = 0.116, p = 0.027). Age, job rank, years of service, and education level were significantly associated with commitment (all p < 0.05). Multiple regression indicated that higher social support (B = 0.206, p < 0.001), greater work stress (B = 0.079, p = 0.006), and older age were independently associated with higher professional commitment (R2 = 0.297). Conclusions: In this cross-sectional sample, COVID-19 infection and long COVID symptoms did not appear to be associated with nurses’ professional commitment. Social support, age, and work stress emerged as the correlates most consistently related to commitment, with social support showing the largest association. Given the observational design and the retrospective measurement of work stress and social support, these findings should be regarded as preliminary and hypothesis-generating rather than conclusive. They tentatively indicate that workplace social support may merit further investigation as a potential avenue for sustaining nurses’ professional commitment during infectious disease outbreaks.

Nursing Reports doi: 10.3390/nursrep16090308

Authors: Jeaneth Linki Matsimbi Maditobane Robert Lekganyane

Background/Objectives: Children and adolescents living with HIV (ALHIV) are among the most vulnerable groups affected by HIV and AIDS. Their vulnerability exposes them to several challenges, such as HIV-related stigma and/or interrupted academic activities due to health-related complications. Since they are still minors who cannot independently make decisions regarding their own lives, most of the challenges extend to their caregivers, who sometimes provide care and support under difficult psychological, social, and economic conditions. This study aimed to explore the lived experiences and challenges of primary caregivers caring for ALHIV in Gauteng Province of South Africa. Methods: A qualitative exploratory design with phenomenological orientation was adopted. Eight primary caregivers of ALHIV were purposively sampled and interviewed using individual face-to-face semi-structured interviews. Data was analysed thematically according to the eight steps of Tesch’s qualitative analysis framework. Since it involved human participants, this study was subjected to ethical clearance by the Research Ethics Committee of the University of South Africa, which imposed conditions for upholding ethical principles such as informed consent and confidentiality. Results: Primary caregivers encounter challenges such as regular monitoring of ALHIV who are always sick, treatment adherence monitoring, behavioural management, financial strain, stigma and discrimination, lack of proper nutrition and managing adolescents’ academic difficulties. These challenges require support from multidisciplinary team members which include nurses because they play a crucial role in supporting treatment adherence among ALHIV and in strengthening the capacity of primary caregivers to provide effective treatment support. Conclusions: It is essential to adopt an integrated approach to psychosocial, as well as financial support interventions targeting primary caregivers.

Nursing Reports doi: 10.3390/nursrep16090307

Authors: Maria Lavdaniti Ioanna Tsatsou Anastasia Asimakopoulou Antzouletta Kampitsi Antonia Vasilopanagi Mpara Ourania Polixeni Liamopoulou Theocharis I. Konstantinidis George Tzavelas

Background/Objectives: Cancer patients undergoing treatment experience a wide range of physical and psychological symptoms that significantly impact their quality of life. This study aimed to evaluate the occurrence and intensity of symptoms in cancer patients using the Edmonton Symptom Assessment System Revised (ESAS-R) during two distinct phases of treatment. Methods: A prospective cohort study with consecutive recruitment of eligible patients within a convenience sample was conducted in a tertiary public cancer hospital in Athens, Greece. The initial sample included 189 adult cancer patients assessed after the third chemotherapy cycle. Of these, 105 patients completed a second assessment after the final chemotherapy cycle and constituted the longitudinal follow-up sample. Symptom intensity was measured using the 10-item ESAS-R self-report tool. Results: The study population was predominantly female (77.2%), married (71.4%), and diagnosed with breast cancer (59.3%). Statistically significant changes between the two measurements (p < 0.05) were observed in pain, fatigue, and well-being. Total symptom burden scores remained relatively stable, slightly decreasing from 25.09 to 24.19. Age showed a consistent negative correlation with pain (p < 0.001) in the second measurement and nausea across both measurements (p = 0.004 and p = 0.017), indicating that younger patients reported higher symptom intensity. Logistic regression indicated that employment/housework was primarily linked to the total symptom score in Measurement A (p = 0.010), with patients less likely to have high symptom severity (Exp(B) = 0.101). Baseline symptom burden category at Measurement A was identified as a significant predictor of symptom intensity at Measurement B (p = 0.028), with patients presenting mild symptom burden at baseline being less likely to report moderate-to-high symptom burden at the final assessment. Conclusions: While pain, fatigue, and perceived well-being deteriorated from the early to the final chemotherapy cycle, the total symptom burden remained relatively stable. Younger patients appeared to experience higher symptom burden, while lower educational level was associated with higher symptom burden in the univariate analysis at the final assessment, highlighting the need for age-sensitive and educationally tailored nursing interventions to enhance symptom management in oncology settings.

Nursing Reports doi: 10.3390/nursrep16090306

Authors: Sergio Martínez-Vázquez Rocío Adriana Peinado-Molina María Antonia Díaz-Ogállar Antonio Hernández-Martínez Juan Miguel Martínez-Galiano

Aim: To evaluate the effect of a student-generated podcast intervention focused on maternal–child health topics on nursing students’ self-perceived knowledge, educational satisfaction, and gameful engagement. Introduction: Health education is essential for promoting healthy lifestyles and preventing disease, making the acquisition of effective communication skills vital for nursing undergraduates. While digital audio media and podcasts are increasingly popular pedagogical tools, traditional applications rely on passive listening. Student-generated podcast production represents an active learning approach that may enhance engagement, communication skills, and content synthesis. Design: Quasi-experimental study without randomization. Methods: The intervention was conducted across a 4-week framework comprising 8 contact hours of faculty guidance alongside independent teamwork. First-year nursing students organized into small collaborative groups (3–4 peers) received initial training on digital audio pedagogy, metadata, and production. Teams developed 5-to-7-min podcast capsules addressing eight evidence-based maternal–child health themes. Faculty provided structured formative checkpoints for script clinical validation and technical audio editing guidance. All completed podcasts were evaluated using a 100-point rubric assessing scientific accuracy (35%), communication clarity (25%), narrative engagement (20%), and technical quality (20%); thirty top-scoring episodes were selected for public radio broadcasting. Pre-and post-intervention self-administered questionnaires measured self-perceived knowledge across all eight topics, educational satisfaction, and gameful experience via the validated 27-item Gameful Experience Scale (GAMEX). Results: A total of 130 valid questionnaires were analysed at each assessment point. Self-perceived knowledge was higher at the post-intervention assessment across all eight topics (all Holm-adjusted p < 0.001). After Holm correction, general podcast satisfaction (adjusted p = 0.036), fulfilment of expectations (adjusted p = 0.036), recommendation to friends or family (adjusted p < 0.001), perceived importance of podcasting for maternal health (adjusted p = 0.036), and perceived ease of setting up a podcast (adjusted p = 0.005) remained statistically significant. Creative Thinking, Mastery, and the overall GAMEX score were nominally higher before multiplicity adjustment, but none remained statistically significant after Holm correction (adjusted p = 0.126, 0.234, and 0.158, respectively). Conclusions: Student-generated podcasting was associated with higher self-perceived knowledge and favourable appraisal on several educational outcomes. GAMEX differences were exploratory after Holm correction.

Nursing Reports doi: 10.3390/nursrep16090305

Authors: Rafael Henrique Marinho Edmundo Martins Junior Geraldo Magela Salomé

Objectives: This study aimed to develop and validate the content of an educational board game aimed at training nurses in the management of friction injuries. Methods: For the development of the game, the Contextualized Instructional Design model was adopted, encompassing the phases of analysis, planning, development, and implementation. The validation of the Friction Care game content involved the participation of 50 expert nurses, who applied the Delphi Technique. Data analysis was conducted using the Content Validity Coefficient (CVC), with the aim of ensuring the consistency and relevance of the proposed items. Results: In the first evaluation round, the judges rated the game’s content as ranging from “inadequate” to “fully adequate.” After corrections based on the suggestions received, the material was resubmitted for analysis and then considered between “adequate” and “fully adequate.” The CVC ranged from 0.94 to 1.0 in the first evaluation and from 0.99 to 1.0 in the second, demonstrating high agreement among experts regarding the quality of the content. Conclusions: The game development and validation of the Friction Care game demonstrated its suitability as an educational resource for training nurses in the management of friction injuries.

Nursing Reports doi: 10.3390/nursrep16090304

Authors: Nader Alnomasy Habib Alrashedi Maha Dardouri Soha Kamel Mosbah Mahmoud Petelyne Pangket Sang Bin You Aluem Tark Deborah Becker Richard Balacuit Maestrado Romeo Mostoles Rayhanah R. Almutairi Ebtsam Abouhashish Sudharani B. Banappagoudar Asim A. Alreshidi Waleed Meajib Alshammari Faisal Fahaad Alrshidi Razan Alsayed Sharifah Alsayed Jiyoun Song

Background/Objectives: High-quality multiple-choice questions (MCQs) are essential for valid assessment in graduate-level nursing programs, yet developing such items is resource-intensive for educators. Large language models such as ChatGPT may generate educational assessment content; however, evidence regarding their effectiveness in producing graduate-level nursing examination items remains limited. This study compared the perceived quality of ChatGPT-generated and educator-authored MCQs for graduate-level nursing examinations and examined exploratory associations between assessor characteristics and quality ratings. Methods: A comparative cross-sectional study was conducted among 27 international nurse educators who independently evaluated 50 MCQs (25 ChatGPT-generated and 25 educator-authored) using an expert-reviewed rubric assessing eight quality domains, with the primary outcome being the between-source difference in perceived quality ratings. Participants were blinded to question source. Results: ChatGPT-generated MCQs received nominally higher ratings than educator-authored items across most domains, but effect sizes were uniformly small (Cohen’s d = 0.11–0.33). No significant differences were observed in perceived difficulty or distractor plausibility; after Bonferroni correction for multiple domain comparisons, differences in cognitive level, scenario relevance, and instructional alignment remained significant. Conclusions: ChatGPT-generated MCQs achieved perceived-quality ratings broadly comparable to educator-authored items when supported by structured prompting and expert refinement, although expert review remains necessary before classroom use, and these results should be regarded as preliminary. These findings support AI-assisted item development as a complementary strategy pending replication in larger, more rigorous studies.

Nursing Reports doi: 10.3390/nursrep16090303

Authors: Worku Animaw Temesgen Yuen Yee Lai Ho Nam Suen Wai Yan Chan Pui Tik Yau Wai Tong Chien Yuen Yu Chong

Background: Mobile health interventions offer a potential solution to adherence challenges, yet evidence regarding their collective efficacy in schizophrenia spectrum disorders has not been formally synthesized. This systematic review evaluates the impact of mobile health (mHealth) interventions on medication adherence as a primary outcome and on daily functioning and psychotic symptoms as secondary outcomes in individuals with schizophrenia spectrum disorders. Methods: Using the Population, Intervention, Comparison, Outcome (PICO) framework, a systematic search was conducted across multiple databases to identify relevant randomized controlled trials (RCTs) evaluating mHealth strategies for medication adherence in adults with schizophrenia spectrum disorders. The PubMed, CINAHL, PsycINFO, EMBASE, and JBI databases were searched from inception until 24 February 2026, using combinations of search terms such as “Schizo” OR “Psychos” AND “mHealth” OR “Digital Health” AND “Medication Adherence”. Data extraction was conducted using a standardized data extraction table and narratively synthesized. This review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, ensuring structured and comprehensive reporting of the findings. Results: Fourteen randomized controlled trials (RCTs) with 1717 participants were included in this review. Four studies evaluated text messaging interventions, four employed phone call interventions, three used electronic medication monitoring systems, and three used mobile applications. Nine of the fourteen studies reported statistically significant improvements in medication adherence. For secondary outcomes, the results were highly inconsistent: only three studies demonstrated significant reductions in psychotic symptoms, and none showed benefits for daily functioning. While various theoretical frameworks, such as the Health Belief Model and Cognitive Behavioral Therapy and intervention modalities, were utilized, the overall evidence was limited by high clinical heterogeneity and a lack of robust long-term data. Conclusions: mHealth interventions, particularly text messaging and mobile applications, demonstrate clear potential to improve medication adherence in individuals with schizophrenia spectrum disorders. Given the high heterogeneity and lack of long-term evidence, future research should prioritize standardized outcome measurements, rigorous designs, and extended follow-up periods to confirm clinical utility.

Nursing Reports doi: 10.3390/nursrep16090302

Authors: Marisol Ignacio Albino Yolanda Hernández Ortega Lorena Chaparro Díaz María de Lourdes Rico González Patricia Cruz Bello Zuleyma González Miguel Nicolas Santiago González María Gicela Pérez Hernandez Ángel Eduardo Bárcenas García María de Lourdes García Hernández

Objective: To identify the clinical manifestations associated with pain in nursing students in emerging adulthood with Long COVID (LC). Methods: A cross-sectional, descriptive, and analytical study was conducted. The universe comprised 1508 students from a Faculty of Nursing in the State of Mexico. The sample size of 307 participants was calculated using Cochran’s formula (1977) with 95% confidence and a 5% margin of error, with correction for finite populations; participants were invited through an open call and selected non-probabilistically according to inclusion criteria and willingness to participate. Instrument: A questionnaire on post-SARS-CoV-2 health conditions was used, with reliability assessed in a pilot test through internal consistency measures, obtaining a Cronbach’s Alpha = 0.86 and KR-20 = 0.87. It was administered between the third and fourth week following the three-month mark after COVID-19 onset. Descriptive analysis, Fisher’s exact test, and a binary logistic regression model were used, with pain as the dependent variable (1 = yes, 0 = no); statistical significance was set at p < 0.05, with a 95% CI. Results: 40.4% of students reported pain—(46.6%) males and (39.0%) females—with a significant association between age group and pain (p < 0.001). A total of 198 painful clinical manifestations were reported: headache (48.0%), chest oppression (26.8%), and myalgias (23.2%). The model showed that taste alteration (p < 0.001) and decreased vision (p < 0.001) were associated with a lower likelihood of pain, while gastrointestinal alterations (p = 0.025) and fatigue (p = 0.048) were associated with a higher likelihood of pain. Conclusions: Pain in students with LC is associated with clinical manifestations, mainly gastrointestinal alterations, and fatigue.