Nursing Reports doi: 10.3390/nursrep16070211

Authors: Marcia A. Docherty Andrea L. Taylor Josh T. Duncan

Background/Objective: Island Health has offered a New Graduate Transition Program (NGTP) since 2005 and refreshed its existing curricular program for the 2022 to 2024 new nurse graduates as the BC healthcare system entered pandemic recovery. Methods: An engaged, action-oriented evaluation strategy, using iterative cycles of Look—Think—Act, was used to inform the program refresh and build relationships with user groups and key interest holders. Results: In 2021, engagement of new graduates in the NGTP ranged from 0.01 to 36%. The refreshed program increased their engagement between 14% and 61%. New graduates leaving Island Health after one year in practice decreased from 7% in 2021 to 4% in 2023. New graduates occupying casual positions decreased from 24% in 2023 to 8% in 2024. Conclusions: This paper underscores the critical importance of intentional relationship building as a foundational element in ensuring new nurse graduates are not only welcomed but successfully integrated into their professional roles with confidence and competence.

Nursing Reports doi: 10.3390/nursrep16070210

Authors: Mengdie Hu Yongxing Bao Wei Zheng Yan Wang Jiawen Fu Xuechun Wang Miao Sun Huiying Tao Zhouguang Hui

Background: Research on nursing interventions for breast cancer patients undergoing radiotherapy is increasing. However, comprehensive mapping and synthesis regarding the field’s overall knowledge structure and development remain limited. This study aims to utilize bibliometric methods to analyze the current status, research hotspots, and emerging trends in this field. Methods: We conducted a bibliometric analysis of 256 publications from the Web of Science Core Collection and PubMed. Results: Publication volume showed a notable increase after 2020 (16–25 articles per year). The United States leads in output (82 articles, 32.0%), followed by China (25 articles). At the institutional level, the University of California, San Francisco (10 articles) is the most productive, while George Washington University leads in total citations (1759). Oncology Nursing Forum is the leading journal both in publication volume (20 articles) and h-index (13). Twelve major research clusters were identified, primarily focusing on symptom management (specifically pain) and psychosocial support. Keyword burst analysis suggests that current frontiers have shifted from acute symptom control toward systematic management approaches and psychological symptom interventions. Conclusions: Based on the analysis of 256 publications and 12 research clusters, this study indicates that the focus of nursing research appears to be expanding from acute symptom control toward comprehensive case management and targeted psychological research. These findings may provide useful directions for future research and clinical practice, particularly regarding the integration of psychosocial care into nursing management.

Nursing Reports doi: 10.3390/nursrep16060209

Authors: Alok Raghav Geetanjali Kalyan Soumya Jyoti Raha Jitendra Meena Jogender Kumar Praveen Kumar

Background: Breastfeeding enhances infant and maternal health, but global breastfeeding rates remain suboptimal. Virtual reality (VR) emerges as a promising tool for breastfeeding education. The objective of this review was to assess the effectiveness of VR-based interventions on breastfeeding outcomes in pregnant and postpartum women. Methods: PubMed, Embase, Web of Science, Scopus, and CENTRAL were searched until 10 January 2026, for randomized controlled trials (RCTs) and quasi-experimental studies comparing VR-based interventions (immersive simulations, 360° videos, or head-mounted displays) with standard care or non-VR comparators in pregnant or postpartum women. Primary outcomes included breastfeeding self-efficacy, motivation, and breastfeeding technique (LATCH score). Secondary outcomes included exclusive breastfeeding rates, milk production, and maternal anxiety. Risk of bias was assessed using the RoB 2.0 and ROBINS-I tools for RCTs and non-RCTs, respectively. A random-effects meta-analysis was conducted, with results reported as mean differences (MD) or risk ratios (RR), along with 95% confidence intervals (CIs). Certainty of the evidence was assessed using the GRADE approach. Results: Five studies (4 RCTs and 1 quasi-experimental; n = 344) were included. VR improved prenatal breastfeeding self-efficacy (2 studies, MD: 13.93; 95% CI: 10.96–16.90), motivation (1 study, MD: 2.88; 95% CI: 1.66–4.10), and LATCH score (1 study, MD: 1.72; 95% CI: 1.37–2.07), and reduced time to breastfeeding initiation (1 study, MD: −22.4 min; 95% CI: −29 to −15.9), the certainty of evidence was low to very low for these outcomes. No significant effects were observed for postnatal self-efficacy, exclusive breastfeeding, or maternal anxiety. Formal assessment of publication bias could not be done. The small sample sizes for most outcomes, heterogeneity, the open-label nature of the trials, and the subjective nature of the outcomes should be considered when interpreting these results. Conclusions: VR-based interventions may improve process outcomes, such as prenatal breastfeeding self-efficacy, motivation, breastfeeding technique, and early breastfeeding initiation; the certainty of evidence is low to very low. Evidence for clinically important outcomes, including exclusive breastfeeding and maternal anxiety, remains inconsistent. Larger, well-designed RCTs are warranted before these interventions can be considered in routine practice.

Nursing Reports doi: 10.3390/nursrep16060208

Authors: Habib Alrashedi Omar Almaslamani Nader Alnomasy Khalil A. Saleh Hamdi Lamine Sameer A. Alkubati

Background/Objectives: While previous research has explored the effects of moral distress and the work environment separately, there is limited evidence on how these two factors are associated with nurses’ turnover intention. Therefore, in this study, we assessed the mediating role of moral distress in the correlation between nurses’ work environments and turnover intention. Methods: This study employed a multicenter cross-sectional design of emergency nurses from April to June 2025. The Measure of Moral Distress—Healthcare Professionals, Practice Environment Scale of the Nursing Work Index (PES-NWI), and Turnover Intention Scale were used to collect data. The mediating effect was analyzed using Hayes’ PROCESS macro (Model 4, Version 4.2) software with the bootstrap technique (5000 repetitions, 95% bias-corrected confidence interval). Statistical significance was set at a threshold of p < 0.05. Results: Mediation analysis revealed that work environment had a significant negative effect on moral distress (β = −0.251, B = −45.293, 95% CI [−70.376, −20.210], p < 0.001). Moral distress significantly increased nurse turnover (β = 0.202, B = 0.008, 95% CI [0.003, 0.012], p = 0.003), while the work environment had a significant negative direct effect on turnover (β = −0.391, B = −2.629, 95% CI [−3.507, −1.751], p < 0.001). The total effect of work environment on nurse turnover was also significant (β = −0.442, B = −2.970, 95% CI [−3.837, −2.102], p < 0.001). Bootstrapping confirmed a significant indirect effect of moral distress (β = −0.051, 95% CI [−0.092, −0.016]), indicating partial mediation. Conclusions: This study revealed that nurses’ work environment was significantly associated with turnover intention, both directly and indirectly, through moral distress. Moral distress acted as a statistically significant but modest partial mediator of the association between the work environment and turnover intention, suggesting that it may partially explain this relationship. Strategies by healthcare organizations should be organized to optimize proactive work environments and mitigate moral distress among nurses.

Nursing Reports doi: 10.3390/nursrep16060207

Authors: Hyunmin Lee Sukjae Park Eunhee Shin

Background: This study examined how clinical nurses’ communication competence, grit, and leader–member exchange (LMX) contribute to nursing performance, aiming to identify key predictors to support workforce development and organizational policy planning. Methods: This study was conducted as a descriptive correlation study targeting 190 clinical nurses working at a general hospital in S City. Data were collected through a self-report questionnaire and analyzed using descriptive statistics, t-test, ANOVA, Pearson correlation coefficient, and hierarchical regression analysis using the IBM SPSS/WIN 25.0 program. Results: On a 5-point scale, the mean score of nursing performance was 4.05. Communication skills (β = 0.52, p < 0.001), grit (β = 0.23, p = 0.002), and clinical experience (β = 0.18, p = 0.022) significantly affected nursing work performance, with communication skills having the greatest effect. This model explained 47.3% of the nursing performance. Conclusions: To improve the nursing performance of nurses, strengthening communication skills and grit, supporting professional development, and recognizing clinical experience are crucial. These findings suggest that integrating such programs into ward nurse training may contribute to improved nursing performance and organizational effectiveness. To develop these competencies and evaluate their effectiveness, follow-up research is continuously needed.

Nursing Reports doi: 10.3390/nursrep16060206

Authors: Gabriele Caggianelli Marco Iorfida Fabio Petrelli Maurizio Fiorda Marco Ricci Samanda Pettinari Francesca Marfella Roberto Accettone Valentina Vanzi Gennaro Rocco Francesco Scerbo Stefano Mancin Maurizio Zega Giovanni Cangelosi

Background/Aims: The increasing complexity of disasters requires effective integration of nurses into Civil Defense (CD) systems. Despite their crucial role, the competencies needed to operate within these multi-agency frameworks remain fragmented and insufficiently defined. The main aim of the study was to map nursing competencies for disaster response within the CD context, identifying essential skills, contextual variations, and barriers to application. Methods: A scoping review was conducted following the JBI methodology and reported according to PRISMA-ScR guidelines. Major databases (PubMed, CINAHL, Scopus, Embase) were searched without time limits, resulting in the inclusion of 27 studies published between 2011 and 2025. Results: 12 core competency domains were identified. Clinical care was the most cited competency (70% of studies), followed by communication (63%), leadership (60%), triage (48%), and psychosocial support (48%). The lack of specific training emerged as the primary individual barrier (44%), while the absence of standardized curricula was the leading systemic obstacle (41%). Competency requirements varied significantly based on the hazard type and organizational setting. Conclusions: Disaster nursing is emerging as an essential specialized field in response to the increasing frequency of climate-related events and global conflicts. There is an urgent need to move beyond purely clinical training to integrate “organizational literacy” and psychological resilience, harmonizing educational pathways with national CD policies and competency-based disaster preparedness programs.

Nursing Reports doi: 10.3390/nursrep16060205

Authors: Thu-Thuy Thi Nguyen Huu Thuan Vo Thi Tuong Vi Nguyen Pham Minh Son Vu Thi Xim Thi My Nhung Pham Mieu An Phan Thi Anh Nguyen

Background: Patient-reported outcome comparisons require measurement equivalence, which is seldom tested in low- and middle-income country (LMIC) diabetes research. We examined equivalence of the Diabetes Self-Management Instrument-35 (DSMI-35), Diabetes Distress Scale-17 (DDS-17), and Asian Diabetes Quality of Life (AsianDQOL) scale across sex, fasting-glucose stratum, and educational attainment in Vietnamese adults with type 2 diabetes. Methods: We conducted a secondary analysis of 374 adults (female 152, male 222; lower-FBG < 154 mg/dL, n = 212; higher-FBG n = 162; secondary-or-lower n = 202; tertiary-or-higher n = 172). Multi-group CFA (lavaan) tested configural, metric, and scalar equivalence of a parcel-level three-factor model (parcel-level equivalence does not imply item-level equivalence). Path equality was evaluated with scaled Satorra–Bentler likelihood-ratio tests; indirect effects were bootstrapped (n = 5000). Results: Scalar-equivalence change-index criteria (ΔCFI ≤ 0.010; ΔRMSEA ≤ 0.015) were met for all groupings; however, for fasting glucose the configural baseline fit was weak (RMSEA 0.117–0.119), so fasting-glucose equivalence is reported only as provisional and is not interpreted at the level of the sex and education findings. McDonald’s ω was ≥ 0.959 in every subgroup. Structural paths did not differ by sex (Δχ2(3) = 1.18, p = 0.758; not powered for equivalence) but differed by education (Δχ2(3) = 71.16, p < 0.001), with the cross-sectional association structure differing by education (distress-channelled in tertiary-or-higher and partly direct in secondary-or-lower participants); because the data are cross-sectional, these are differences in association structure, not established mediation. The fasting-glucose structural comparison was not interpretable because the lower-FBG subgroup (FBG < 154 mg/dL, n = 212) had a non-positive-definite latent covariance matrix. Conclusions: Scalar equivalence criteria were met for sex and education and only preliminarily supported for fasting-glucose stratum, where elevated configural RMSEA (0.119) cautions against firm interpretation. The self-management → distress → quality-of-life pathway showed no detected sex difference but differed by educational attainment. Measurement equivalence testing, including configural-fit assessment, should be routine in LMIC patient-reported outcome validation.

Nursing Reports doi: 10.3390/nursrep16060204

Authors: Eric Lim Takeshi Hamamura Jaya Dantas Sender Dovchin Stephanie Dryden Ana Tankosić

Background: Culturally and Racially Marginalised (CaRM) communities in Australia encounter subtle and covert forms of prejudice, commonly referred to as “new racism”. Within healthcare settings, these experiences can shape trust, engagement, and patterns of help-seeking. Mental health nurses are often the first point of contact in care delivery, and their ability to recognise, respond to, and mitigate the impacts of new racism is critical for fostering therapeutic relationships and supporting equitable access. Understanding how CaRM communities perceive the conditions that influence their mental health service use is fundamental for informing more equitable and culturally responsive care. Objective: This study explored the viewpoints of CaRM community members regarding the factors they consider important for addressing new racism in healthcare systems and supporting engagement with mental health services. Design: Q methodology was used to identify statistically derived viewpoints that reflect shared viewpoints about the conditions perceived as critical for addressing the impacts of new racism on mental health service use. Setting: Participants were recruited from culturally and linguistically diverse communities across Australia through community settings, social media, and professional networks. Participants: Thirty-five individuals from CaRM backgrounds completed the Q-sort. Methods: This Q methodology consisted of five steps: (1) set up of the Q-sorting instrument, (2) selection of participants, (3) data collection, (4) factor analysis, and (5) factor interpretation. Results: Three distinct viewpoints were identified: (1) raising awareness of mental health issues within CaRM communities (community-focused), (2) providing visible anti-racism and culturally safe services (service-focused), and (3) recognising and formally addressing new racism within healthcare systems (policy-focused). Conclusions: This study offers the first empirically derived, community-informed set of viewpoints on addressing new racism in Australian mental healthcare. While exploratory, the findings highlight multi-level considerations that are potentially relevant to mental health nursing practice, and may be useful to inform future research, policy development, and service redesign aimed at strengthening cultural responsiveness and equity in mental health systems.

Nursing Reports doi: 10.3390/nursrep16060203

Authors: Giulia Villa Andrea Poliani Alessia Campoli Annarita Coppola Francesco Carlo Denti Rossella Guzzi Danila Maculotti Marina Perrotta Clara Salazar Giovanni Sarritzu Monica Sgherri Antonio Valenti Pier Raffaele Spena Duilio Fiorenzo Manara

Introduction: Remote education is increasingly used in ostomy care, but its components, timing, governance, and evaluation remain inconsistently defined. This study aimed to develop practice-oriented recommendations for implementing remote patient education for people living with an ostomy. Methods: An Italian expert consensus using a modified Delphi method and reported according to the ACCORD guidelines was conducted. An expert panel (n = 11), recruited nationally, included stomatherapists (n = 6) and people living with an ostomy (n = 5). Round 1 comprised a remotely conducted focus group to generate and refine statements informed by a targeted literature search. Rounds 2 and 3 were anonymous online surveys in which panelists rated statements on a four-point Likert scale and could provide comments or propose additional items. Consensus was predefined as ≥75% agreement. Results: Response rates were 100% across the three rounds (October–November 2025). The panel achieved consensus on 8 definitions and 14 statements, organized into six domains: (1) model of care and eligibility; (2) privacy and data protection; (3) program structure, outcomes, and evaluation; (4) educational content and teaching strategies; (5) timing, intensity, follow-up, and caregiver involvement; and (6) dignity, relational quality, and professional and organizational requirements. Recommendations supported a hybrid-by-default model with eligibility criteria, privacy-by-design using secure platforms and traceable documentation, structured programs with tailored multimodal content, staged pathways lasting 2–6 months after an initial in-person foundation, dignity-preserving options during remote encounters, professional training in communication and digital empathy, and integration into clinical planning and records. Conclusions: This consensus provides the first ostomy-specific, implementation-focused recommendations for standardizing remote patient education in Italy, with an emphasis on equity, privacy, dignity, evaluation, and workforce competencies.

Nursing Reports doi: 10.3390/nursrep16060202

Authors: Elena Andina-Díaz Bárbara Santamarta-Fernández Elena Fernández-Martínez

Background: Community-based mental health and social interventions focusing on housing stability, integrated care and psychosocial support are being increasingly recognised as essential for improving the mental health and wellbeing of people experiencing homelessness. However, evidence regarding the effectiveness of these interventions remains fragmented across different models of care and study designs. This review synthesises how these interventions address mental health and social determinants of health. Methods: Following PRISMA 2020 guidelines, a systematic search of six electronic databases (2019–2025) was conducted (PROSPERO: CRD420250653260). The review included 29 quantitative, qualitative, and mixed-methods studies examining community-based interventions for people experiencing homelessness and mental health conditions according to predefined eligibility criteria. Methodological quality was assessed using the Mixed Methods Appraisal Tool. Results: Community-based interventions, particularly Housing First models, were frequently associated with improved housing stability, mental health outcomes, and programme retention. Integrated multidisciplinary services and outreach promote psychosocial wellbeing, continuity of care and reducing emergency service use. Peer-led programmes support social integration, although evidence regarding technology-based interventions was inconsistent, with some studies reporting improved engagement and access to support, while others found limited effects on mental health outcomes. Conclusions: Addressing social determinants of health through structured community-based interventions is essential to tackle mental health inequalities. The findings support the implementation of integrated community-based services combining housing, mental health, and social support. These results may inform policymakers, healthcare providers, and community organisations seeking to reduce mental health inequalities among people experiencing homelessness.

Nursing Reports doi: 10.3390/nursrep16060201

Authors: Catarina Simões Margarida Vieira Ana Paula Sapeta

Background/Objectives: Recognizing and managing grief is particularly important in nursing, especially from the perspective of family caregivers. In this qualitative study, we aim to understand the grieving process of family caregivers, focusing on what happens before the death of an adult family member due to chronic illness, and to identify the factors influencing the grieving process in this context. Methods: This study is an outcome of a broader study which aimed to understand how family caregivers grieve during the first year following the death of an adult family member due to a chronic illness. This article will only address the influencing conditions that emerged from data related to events that occurred prior to the person’s death. A theoretical sample was gathered through semi-structured interviews with 20 bereaved family caregivers. Data were collected and then analyzed independently by the research team using the three stages and principles of Strauss and Corbin’s grounded theory. Results: Adaptation was identified as the central category. Before death, the family caregiver undergoes two adaptive processes: adapting to their new role and preparing for the imminent loss. As they adapt to this loss, they become aware of the seriousness of the illness and the inevitability of death, opening the possibility for the grieving process to begin. The process is influenced by personal and contextual factors as well as interaction-related factors, including access to information, satisfaction with the care provided, recognition of their efforts, and feelings of abandonment or interaction with healthcare professionals. A wide range of emotions and feelings are experienced. This experience is colored by hope and anticipatory grief. The meaning of the dying process is explored and expectations are redefined. Conclusions: The grieving process experienced by family caregivers is an adaptive process that begins before the patient’s death. Some conditions can be modified before the patient’s death; in this case, nurse interventions can enhance the experience of family caregivers.

Nursing Reports doi: 10.3390/nursrep16060200

Authors: Yufei Xing Xiaolong Wang Enming Zhang Jiajia Yu Qiong Fang

Background: The legal dimensions of nursing practice have become increasingly complex, yet the concept of legal literacy in clinical nurses remains insufficiently defined. Existing studies use terms such as legal knowledge, legal awareness, legal cognition, and law-based practice capacity inconsistently, which hinders conceptual clarity, valid measurement, and targeted educational intervention. This study aimed to clarify the conceptual boundaries, defining attributes, antecedents, consequences, empirical referents, and operational definition of legal literacy in clinical nurses. Methods: A concept analysis was conducted using Walker and Avant’s eight-step method. A systematic literature search was performed across six databases and supplemented by searches in JSTOR and HeinOnline for non-clinical uses of the concept. The search covered database inception to December 2024. Screening and reporting followed PRISMA 2020 guidelines. Fifty-six papers were included. Data extraction and analysis were conducted using content analysis with independent dual-reviewer coding. Results: Legal literacy in clinical nurses was distinguished from four related concepts: legal knowledge, legal awareness, legal cognition, and medical ethics. Three defining attributes were identified: normative understanding, value internalization oriented toward rights and responsibilities, and law-based situational practice. Antecedents were identified at macro, meso, and micro levels, while consequences were observed for individual nurses, healthcare organizations, and patient rights. Analysis of empirical referents revealed a persistent gap between conceptualization and measurement, particularly in assessing law-based situational practice. An operational definition was developed accordingly. Conclusions: Legal literacy in clinical nurses is a multidimensional professional competency integrating legal understanding, rights- and responsibility-oriented value internalization, and the ability to translate these into lawful clinical action. The findings provide a conceptual basis for future instrument development and targeted educational and management interventions.

Nursing Reports doi: 10.3390/nursrep16060199

Authors: José Manuel García-Álvarez Alfonso García-Sánchez José Luis Díaz-Agea

Background/Objectives: Given the complexity of current healthcare, working in highly cohesive teams is essential. Clinical simulation can promote group cohesion among healthcare teams. There are different learning methodologies in simulated environments capable of developing group cohesion in healthcare teams. The objective of this study was to compare group cohesion outcomes between two clinical simulation learning models—self-directed (Self-Learning Methodology in Simulated Environments, MAES©) and non-self-directed (Simulation-Based Learning, SBL)—in nursing student teams. Methods: A quasi-experimental pre–post study with a control group was conducted among 311 fourth-year nursing students from two Spanish universities. The primary outcome was group cohesion, assessed using the Spanish short version of the Group Environment Questionnaire (GEQ) total score and its dimensions. The questionnaire was administered twice, before and after participation in clinical simulation sessions. The experimental group used the MAES© methodology, while the control group used SBL. Between-group differences were analyzed using analysis of covariance (ANCOVA), adjusting post-intervention scores for baseline values. Within-group pre-post changes were explored as a secondary analysis using the Wilcoxon signed-rank test. Results: No significant differences in baseline group cohesion were found. After the intervention, both methodologies were associated with improvements in group cohesion over time. Adjusted analyses (ANCOVA) showed statistically significant between-group differences favoring MAES© across all dimensions, with small-to-medium effect sizes (ηp2 = 0.036–0.138). Conclusions: Both simulation methodologies were associated with improvements in group cohesion among nursing students. Adjusted between-group differences were observed across all dimensions, associated with higher adjusted scores in the MAES© group. However, given the non-randomized design these findings should be interpreted as associations rather than evidence of causality. Further randomized controlled trials are needed to confirm these results.

Nursing Reports doi: 10.3390/nursrep16060198

Authors: Marciana Fernandes Moll Lucas Duarte Silva Giovana Pires Borges Ana Paula Rigon Francischetti Garcia Erika Christiane Marocco Duran Joaquim Manuel de Oliveira Lopes Vanessa Pellegrino Toledo

Background/Objectives: The escalation of psychiatric symptoms can pose risks to the safety of the patients and members of the health care team, particularly nursing staff who are in direct and constant contact with these patients whilst providing care. This study aimed to describe the reality experienced by nursing teams responding to crisis situations in Psychosocial Care Network services. Methods: Action research was conducted, for which data were collected using the focus group technique, with the participation of 10 to 11 nursing professionals. Twelve sessions were held using this technique, two for each of the six groups. For data analysis, full transcription and coding were performed using the Atlas TI Software (Version 23) to identify themes. Data analysis was developed using the thematic analysis technique. Results: The identified data categories are as follows: professionals’ perceptions of nursing team performance in caring for people in crisis; meanings attributed by professionals to situations of aggression during crises; and needs to be met for better management of people in crisis. Conclusions: Decentralizing responsibilities among the team and within the Network, including interdisciplinary care, makes it possible to provide comprehensive care for people in crisis. It is necessary to put integrated measures in place to safeguard the health of nursing staff working in Psychosocial Care Network services.

Nursing Reports doi: 10.3390/nursrep16060197

Authors: Marisa de Paula Diogo Folgado Ana João Ana Madeira

Background: The perioperative context is characterized by high complexity and a significant risk of adverse events, requiring highly developed technical and non-technical competencies. Structured clinical supervision has been identified as a relevant strategy for professional development and for promoting the quality and safety of care, although the specific evidence in this context remains dispersed. Objective: To analyze the available scientific evidence on the impact of structured clinical supervision on nurses’ professional development and on the quality and safety of care delivered in the perioperative setting. Methods: A systematic literature review was conducted in accordance with PRISMA 2020 recommendations. The search was performed in the PubMed, Web of Science, EBSCO, SciELO, BVS, and CONSENSUS databases and included studies published between January 2020 and October 2025 in Portuguese, English, or Spanish with full-text availability. The research question was structured according to the PICO strategy. Study selection was carried out in multiple stages (duplicate removal, screening by title and abstract, and full-text review), performed by two independent reviewers. Methodological quality was assessed using the Joanna Briggs Institute (JBI) checklists. Data synthesis was conducted through thematic narrative analysis, given the methodological heterogeneity of the included studies. Results: Twelve studies were included, predominantly qualitative and observational in nature, as well as psychometric validation studies, one Delphi study, and one quasi-experimental study. The findings show consistent convergence regarding the association between structured clinical supervision and the development of technical and non-technical competencies, namely communication, leadership, teamwork, situational awareness, and decision-making. The use of structured assessment instruments demonstrated good psychometric reliability and improved the quality of supervisory feedback. Organizational factors, such as protected time, specific training for supervisors, and role clarification, were identified as determinants of the effectiveness of the supervisory process. However, the predominance of non-experimental designs and the scarcity of objective clinical outcomes limit direct causal inference between structured supervision and measurable reduction in adverse events. Conclusions: The available evidence suggests that structured clinical supervision is a relevant component for the professional development of perioperative nurses and for strengthening the safety culture in the operating room. Despite the high conceptual consistency of the findings, the overall strength of evidence is moderate, and experimental and longitudinal studies are needed to consolidate the impact of supervision on objective clinical indicators of care quality and safety.

Nursing Reports doi: 10.3390/nursrep16060196

Authors: Kechi Iheduru-Anderson Christiana O. Akanegbu Chimezie J. Agomoh Roop C. Jayaraman

Background: Black Sub-Saharan African immigrants are among the fastest-growing immigrant populations in the United States, and their mental health needs, particularly with respect to depression, remain understudied. Cultural beliefs, linguistic frameworks, and coping practices in this population often diverge from Western psychiatric models, suggesting that conventional approaches may fail to capture how distress is experienced and expressed. Objective: This scoping review mapped literature on how Black Sub-Saharan African immigrant adults in the United States perceive, report, and respond to depression. Methods: Following PRISMA-ScR guidelines, six electronic databases were systematically searched for empirical studies published between 2000 and 2026. Two reviewers independently screened and extracted data using a standardized form. Data were analyzed using a narrative synthesis approach combining deductive thematic categorization across three predefined review domains with inductive identification of subthemes through iterative team discussion and consensus, with sociocultural, religious, linguistic, and structural factors examined as cross-cutting themes. Findings were synthesized narratively across three domains: perceptions of depression, reporting and communication, and responses to depression. Results: A total of 19 studies met the inclusion criteria (7 quantitative, 10 qualitative, 2 mixed methods; total N ≈ 1900), generating 24 themes. Perception themes highlighted cultural non-recognition of depression (12 of 19 studies), absence of equivalent terms in African languages (7 studies), spiritual explanatory models, and profound stigma. Reporting patterns showed predominant somatic symptom expression and very low disclosure to providers (2.6–4.2%), with depression prevalence ranging from 8.1% to 100% and no validated screening instrument identified for this population. Response themes emphasized religion and social support as primary coping strategies, with formal mental health utilization virtually absent due to structural, cultural, and intersectional barriers. Conclusions: Depression among Black Sub-Saharan African immigrants is widely experienced yet rendered invisible through interlocking cultural, linguistic, somatic, and institutional mechanisms, which this review terms an architecture of invisibility, leaving it largely unaddressed by formal mental health systems. The identification of only one intervention study underscores a substantial gap between documenting the burden of depression and advancing evidence-informed solutions. Culturally validated measures, faith-based intervention models, longitudinal designs, and attention to structural determinants are urgently needed.

Nursing Reports doi: 10.3390/nursrep16060195

Authors: Reda Elsahy Thaer Momani

Background/Objectives: Maintaining oral hygiene in infants in neonatal and pediatric intensive care is essential for preventing ventilator-associated pneumonia (VAP). Chlorhexidine (CHX) is widely used in adults but its safety and efficacy in infants remain uncertain, and it is not recommended for children under 6 years due to rinsing difficulties and mucosal irritation risk. Expressed breast milk (EBM), rich in immunological and antimicrobial components, has been explored as a biologically appropriate alternative. This review synthesizes evidence on EBM effectiveness and safety and contextualizes it against limited indirect evidence for CHX, as no head-to-head comparative trials were identified. Methods: A systematic search of PubMed, EMBASE, Cochrane Library, CINAHL, and Web of Science (January 2015–January 2026) identified randomized and non-randomized studies involving infants ≤ 12 months receiving EBM, colostrum, or CHX for oral care. Risk of bias was assessed using RoB 2 for RCTs and ROBINS-I for non-RCTs. Due to substantial clinical and methodological heterogeneity (differing populations, dosages, frequencies, delivery methods, and outcome definitions), a narrative synthesis was performed. Results: Seventeen studies met inclusion criteria (11 RCTs, n = 1185; 6 non-RCTs, n > 3000). EBM and oropharyngeal colostrum were associated with trends toward lower VAP incidence trends (0–4%), reduced bacterial colonization, improved oral health indices, shorter mechanical ventilation time, and reduced ICU/hospital stays, with no reported adverse events. Evidence for CHX in infants was limited to a single paediatric RCT and bundled interventions, showing no significant VAP reduction and associations with mucosal irritation. The risk of bias was generally low to moderate. Conclusions: Indirect evidence suggests EBM is a potentially beneficial option for infant oral hygiene, with favourable trends for infection-related outcomes and recovery parameters. However, all EBM–CHX comparisons are indirect, and CHX evidence in infants is limited by the risk of bias and heterogeneity. High-quality head-to-head randomized controlled trials are needed to determine optimal strategies and inform guidelines.

Nursing Reports doi: 10.3390/nursrep16060194

Authors: Hortência Fernandes Layze Braz de Oliveira Marília Duarte Valim Herica Emilia Félix de Carvalho Daniela Reis Joaquim de Freitas André Luiz Silva Alvim Daniel de Macedo Rocha Aires Garcia dos Santos Júnior Beatriz Maria Jorge Inês Fronteira Álvaro Francisco Lopes de Sousa

Background/Objectives: Urinary catheterization is common across care settings, but safe management at home and during care transitions often depends on caregivers who receive limited and inconsistent training. Mobile health (mHealth) applications may support caregiver education and decision-making. This review mapped and synthesized evidence on interactive mobile applications for caregiver training in urinary catheterization and developed a conceptual framework to inform nursing practice. Methods: A scoping review was conducted according to Joanna Briggs Institute guidance and reported following PRISMA-ScR. Searches were performed in PubMed/MEDLINE, Scopus, Web of Science, and LILACS, with complementary grey literature searches. Studies evaluating interactive mobile applications for caregiver training in urinary catheterization were included. Data were extracted and synthesized descriptively and narratively. Results: Five studies published between 2020 and 2025 were included. Most were early-stage studies with small samples and heterogeneous designs. Interventions generally combined educational content with interactive features, such as decision-support tools, and less often behavioral strategies, including reminders and feedback. Outcomes mainly addressed knowledge, skills, and self-efficacy, while clinical outcomes, such as infection reduction, were rarely assessed. A conceptual framework was developed showing how intervention components may influence caregiver competence and care outcomes, moderated by contextual factors such as health literacy and digital access. Conclusions: Interactive mobile applications may represent a promising approach to support caregiver training and improve the safety of urinary catheter management. However, current evidence remains preliminary and limited.

Nursing Reports doi: 10.3390/nursrep16060193

Authors: Viktorija Zalpyte Indre Cergelyte-Podgrusiene

Background: Operating room nurses are exposed to high levels of occupational stress, making them particularly vulnerable to burnout. Psychological resources such as self-esteem may play a protective role; however, evidence in perioperative settings remains limited. Objective: This study aimed to examine the relationship between self-esteem and burnout among operating room nurses. Methods: A quantitative cross-sectional study was conducted among 261 operating room nurses working in public healthcare institutions in Vilnius, Lithuania. Self-esteem was measured using the Rosenberg Self-Esteem Scale (RSES), and burnout was assessed using the Burnout Assessment Tool (BAT-23). Data were analyzed using non-parametric tests, Spearman’s correlation, hierarchical regression analysis, and Bonferroni correction for multiple comparisons. Results: A statistically significant negative association was found between self-esteem and burnout (p < 0.001). Higher self-esteem was associated with lower levels of exhaustion (r = −0.326), emotional distress (r = −0.357), cognitive impairment (r = −0.398), and psychological disengagement (r = −0.331). The strongest associations were observed for secondary symptoms (r = −0.420) and overall burnout (r = −0.410). In regression analysis, self-esteem remained a significant predictor of burnout (β = −0.438, p < 0.001), explaining a substantial proportion of variance. Conclusions: Self-esteem is a significant protective factor against burnout among operating room nurses. Interventions aimed at strengthening psychological resources may contribute to reducing burnout in high-intensity clinical environments.

Nursing Reports doi: 10.3390/nursrep16060192

Authors: Yumi Mizuochi Yukako Shigematsu Yoshitomo Fukuura Kyoko Miwa

Background/Objectives: Improved survival rates have led to an increase in the number of children with medical complexity (CMC) receiving home-based care. However, there is a lack of clarity regarding the relationships among collaborative environments, environmental modifications, and positive family health among families of CMC in daily living settings. This study aimed to examine these relationships and identify their associated factors. Methods: This study was a secondary analysis of data derived from a self-administered questionnaire that was distributed to the families of CMC with experience in organizing the care environment. Ninety responses were included in the study, and regression analyses were performed using complete cases (n = 41–63). Results: Family-led environmental modifications (β = 0.670, p < 0.001) and physical environmental modifications (β = 0.679, p = 0.015) were positively associated with the collaborative environment, whereas professional-facilitated family-led environmental modifications were negatively associated with the collaborative environment (β = −0.775, p = 0.009). Regarding positive health in families, family-led environmental modifications (β = 0.487, p = 0.018), environmental modifications for care improvement (β = 0.597, p = 0.031), pre-modification family well-being (β = 0.464, p < 0.001), and the presence of someone to consult (β = 0.330, p = 0.011) were significantly associated with positive health in families. Because this study employed a cross-sectional design, causal relationships cannot be inferred. Conclusions: Collaborative environments in daily living settings may be associated with family involvement, physical environmental conditions, and professional engagement. Healthcare professionals may support family autonomy and participation in environmental modification processes.

Nursing Reports doi: 10.3390/nursrep16060191

Authors: Jalal Uddin Tazveen Fariha Shahida Sultana Shumi Farzana Rahman Md Ariful Islam Susmita Saha Proma Bishwajit Sarker

Background: Adults with type 2 diabetes increasingly use patient portals, telemonitoring systems, mobile applications, text messaging programs, and other digital services to support self-management. In practice, however, these approaches often still depend on nursing support to help patients understand, use, and sustain digital care in everyday settings. This scoping review mapped how nurses are involved in supporting adults with type 2 diabetes to use digital tools, information, and services for self-management across care settings. Methods: This scoping review followed Joanna Briggs Institute methodology and was reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. The review question was guided by the Population, Concept, and Context framework. A literature search was conducted in January 2026 in PubMed, Scopus, Embase, and EBSCO/CINAHL. A total of 230 records were identified, 71 duplicates were removed, and 159 records underwent title and abstract screening. Fifty-three full-text articles were assessed for eligibility, and 15 studies met the inclusion criteria. Data were extracted using a structured charting table and synthesized descriptively and thematically. Results: The 15 included studies were published between 2021 and 2026 and represented evidence from 10 countries across primary care, community health centers, telehealth programs, and hospital-linked services. Five interrelated themes were identified: nurses as digital self-management educators; nurses as remote monitors and care coordinators; nurses as facilitators of digital engagement, confidence, and supported use; nurses as implementation partners in digital diabetes care; and equity, access, and context as shaping conditions of digital diabetes support. Only one study directly measured digital health literacy, whereas the remaining studies addressed digital engagement more indirectly through onboarding, portal communication, telemonitoring, reminders, tailored feedback, and implementation work. Common barriers included workload, unclear responsibilities, technical difficulties, age- or literacy-related access challenges, language needs, and uneven infrastructure. Conclusions: The included studies suggest that nurses commonly contributed to making digital diabetes care more understandable, usable, and actionable for adults with type 2 diabetes. Their roles were described across education, monitoring, coordination, implementation, and support for digital engagement. Future studies could measure digital health literacy more explicitly, describe nursing tasks in greater detail, and examine how equity-related factors shape digital diabetes care.

Nursing Reports doi: 10.3390/nursrep16060190

Authors: Era Dorihi Kale Nursalam Nursalam Makhfudli Makhfudli Rapin Polsook I Gede Juanamasta

Background/Objectives: Tuberculosis (TB) treatment adherence remains suboptimal globally, contributing to relapse, transmission, and drug-resistant TB. Adherence is a culturally embedded behavioral process shaped by psychological readiness, social relationships, and structural conditions. This study aimed to validate a culturally grounded counseling model integrating the Sunrise Model of transcultural nursing and the Information–Motivation–Behavioral Skills (IMB) framework for TB treatment adherence in Kupang City, Indonesia. Methods: A cross-sectional study enrolled 172 pulmonary TB patients across all 11 primary healthcare centers in Kupang City (June–September 2025). A validated questionnaire measuring eight transcultural determinants, culturally grounded counseling (mediator), and adherence (outcome) was developed through expert validation, cognitive interviewing, and pilot testing. Structural Equation Modeling–Partial Least Squares (SEM-PLS) tested structural and mediation relationships via bootstrapped indirect effects (p < 0.05). Results: Reliability (CR: 0.842–0.959; ρA: 0.791–0.957), convergent validity (AVE: 0.577–0.921), and discriminant validity (all HTMT < 0.85) were confirmed. The model showed strong explanatory power (R2 = 0.649 for adherence; SRMR = 0.074). Culturally grounded counseling was positively associated with adherence (β = 0.245, p = 0.003) and statistically mediated five antecedent–adherence relationships, including full mediation for economic conditions. Cultural values and lifestyle showed the strongest counseling association (β = 0.345, p < 0.001). Conclusions: Cross-sectional evidence supports a culturally grounded counseling model for TB adherence in diverse settings. Causal conclusions require longitudinal and interventional validation. The model offers a foundation for nurse-led intervention development and multi-site validation.

Nursing Reports doi: 10.3390/nursrep16060189

Authors: Lufei Young Xi Ning Yinghao Pan Tiffany Jackson Meredith Troutman-Jordan

Background/Objectives: Community health nursing (CHN) clinical experiences are essential for preparing undergraduate nursing students to deliver safe and effective home-based care; however, access to placements is often limited. Escape room simulation (ERS) has been used in nursing education, yet its feasibility in CHN remains underexplored. This exploratory study aimed to examine the feasibility of using ERS in undergraduate CHN education by evaluating students’ perceived competence, confidence, and learning experiences following participation in the simulation. Methods: A quasi-experimental, single-group pre–post design was conducted with 56 undergraduate nursing students. Data were collected at three time points: prior to the simulation, immediately after, and ten weeks post-intervention. Measures included standardized assessments of CHN competence and confidence, as well as student perceptions of the simulation experience. Linear mixed-effects modeling was used to examine changes over time. Results: Significant improvements were observed in both competence (t = 6.413, p < 0.001) and confidence (t = 8.142, p < 0.001) following the simulation, with gains maintained at ten weeks. Variability in competence decreased across participants over time, while confidence gains varied individually, with larger improvements among participants with lower baseline scores. Participants reported high levels of satisfaction with the simulation despite limited prior exposure. Conclusions: ERS was associated with improvements in undergraduate nursing students’ perceived competence and confidence, suggesting that it may represent a feasible and acceptable supplemental educational strategy for undergraduate CHN education. Additional research is needed to better evaluate the educational impact and underlying mechanisms of ERS in CHN education, and to support the development of evidence-based ERS approaches that enhance student preparedness for community-based nursing practice in settings where clinical placements are limited.

Nursing Reports doi: 10.3390/nursrep16060188

Authors: Anjana Mary Jacob Satheesh Nair Drew A. Wells Beatrice Bailey M. Dennis Leo

Background: Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related mortality worldwide. Despite established guidelines recommending semiannual surveillance for high-risk patients, real-world adherence remains inconsistent. Gaps in healthcare personnel knowledge and care coordination are recognized contributors to this implementation failure. Methods: Under IRB review, a quality improvement project using the Plan-Do-Study-Act (PDSA) framework was conducted in an ambulatory liver clinic in the southwestern United States. One PDSA cycle was completed. Retrospective and prospective chart reviews (n = 50 charts each) were conducted to assess HCC surveillance ordering and scheduling rates. Thirty healthcare personnel completed investigator-developed pre- and postintervention surveys measuring knowledge and perceptions. Intervention: A structured educational session grounded in current American Association for the Study of Liver Diseases (AASLD) surveillance guidelines was delivered to the full interdisciplinary clinic team, incorporating clinic-specific compliance data and role-specific coordination responsibilities. Results: Knowledge scores improved significantly from a mean of 41.67% to 95.33% (t [29] = −20.27, p < 0.001, d = 3.70). Perception scores improved (Wilcoxon z = −4.30, p < 0.001). Surveillance ordering increased from 88% to 94% and scheduling from 60% to 80%. Conclusions: A single structured educational PDSA cycle was associated with significant improvements in healthcare personnel knowledge and perceptions and with improved ordering and scheduling of HCC surveillance imaging. Postintervention imaging completion and result review rates were not assessed within the available follow-up period. Run chart monitoring of surveillance metrics across subsequent PDSA cycles is planned to evaluate sustainment and guide iterative improvement.

Nursing Reports doi: 10.3390/nursrep16060187

Authors: Sofia Matteucci Gaetano Ferrara Giovanni Cangelosi Ciro Pozzuoli Sara Morales Palomares Pasquale Di Fronzo Anna Grimaldi Angela Durante Marco Sguanci Stefano Mancin on behalf of the Italian Society of Nephrology Nurses (SIAN) Research Group on behalf of the Italian Society of Nephrology Nurses (SIAN) Research Group

Background/Objectives: Nutritional management is a core component of care for patients with chronic kidney disease (CKD), and nephrology nurses play a key role in education and clinical monitoring. However, how nurses develop and enact nutritional competence in daily practice remains insufficiently explored. This study aimed to explore nephrology nurses’ perceptions and experiences of nutritional management in CKD care. Methods: A qualitative descriptive study was conducted through semi-structured interviews with 22 nephrology nurses. Data were analyzed using thematic analysis according to Braun and Clarke. Methodological rigor was ensured following trustworthiness criteria, and reporting adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. Results: The thematic analysis of the interviews identified six main themes: (1) Professional identity and nutritional competence, largely developed through clinical experience rather than structured education. (2) Interprofessional collaboration, perceived as essential but inconsistently implemented. (3) Nutritional education in practice, embedded in daily care and tailored to individual needs. (4) Experiential learning through self-directed nutrition updating. (5) Patient-related challenges, including adherence issues, generational differences, and cultural/educational barriers. (6) Nutritional assessment and decision-making, grounded in routine clinical monitoring and personalized judgment. Participants also highlighted the potential of decision-support tools to enhance personalized nutritional management. Conclusions: Strengthening structured nutritional training, improving interprofessional integration, and implementing shared protocols may enhance the consistency, quality, and safety of nutritional care for patients with CKD, supporting more effective translation of evidence into clinical practice.

Nursing Reports doi: 10.3390/nursrep16060186

Authors: Verónica V. Márquez-Hernández Jessica García-González Miguel Company-Morales Diego Ruiz-Salvador José Miguel Garrido-Molina Alba García-Viola María Margarita Lirola-González Mᵃ Carmen Rodríguez-García

Background/Objective: Service-learning is an educational methodology that has demonstrated benefits and effectiveness in nursing education, generating positive outcomes for both students and the community. However, its application in cardiopulmonary resuscitation (CPR) training remains underexplored. This study explored nursing students’ perceptions of CPR training through service-learning, focusing on dimensions of learning, emotional experience, professional identity, and perceived difficulties in implementation. Methods: A descriptive qualitative study was conducted with 30 nursing students selected through purposive sampling. Data were collected via semi-structured interviews, which were audio-recorded, transcribed verbatim, and thematically analyzed using ATLAS.ti. Results: Four main themes emerged: (1) meaningful learning and consolidation of competencies; (2) emotional impact associated with teaching CPR; (3) increased social awareness and strengthening of professional identity; and (4) perceived difficulties and barriers in implementing service-learning. Conclusions: The results suggest that nursing students perceived service-learning in CPR training as a meaningful learning experience, associated with greater self-confidence, greater emotional engagement, and greater social awareness, despite the perceived barriers.

Nursing Reports doi: 10.3390/nursrep16060185

Authors: Gustavo Gonçalves dos Santos Mónica Alexandra Pinho da Silva Maria João Jacinto Guerra Júlia Maria das Neves Carvalho Ana Cristina Ribeiro da Fonseca Dias Maria Luísa Santos Bettencourt Cely de Oliveira Bruna Feichas Renó Eneida Tramontina Cerqueira Katucha Rocha de Almeida Farias

Background/Objectives: Maternal mortality remains an important indicator of health inequities, reflecting social, regional, and racial inequalities, as well as the responsiveness of health systems. This study aimed to analyze and compare maternal mortality between Brazil and Portugal from 2020 to 2023. Methods: This is a binational ecological and observational study based on secondary data from official records of live births and maternal deaths in both countries. Maternal mortality rates were calculated per 100,000 live births and stratified by sociodemographic and regional variables. Poisson regression models offset by the logarithm of live births were used to estimate adjusted incidence ratios (IRR) and 95% confidence intervals. Analyses were conducted using R and Stata software. Results: Brazil presented rates between 55 and 62 per 100,000 live births, while Portugal maintained lower values, ranging from 8 to 20 per 100,000. In Brazil, higher risks were observed among Black and Indigenous women, residents of the North and Northeast regions, and in age groups above 30 years. Direct and indirect causes showed similar proportions, with an increase in indirect causes during the pandemic. In Portugal, mortality showed low magnitude, but annual fluctuation was attributed to the small number of events and the limitation of microdata. Conclusions: The study highlights strong structural and racial inequalities in Brazilian maternal mortality, contrasting with the lower magnitude and greater stability observed in Portugal. This reinforces the need for intersectoral actions, strengthening the obstetric network, and continuous surveillance to reduce preventable deaths and promote equity in maternal care.

Nursing Reports doi: 10.3390/nursrep16060184

Authors: Simone Amato Vincenza Giordano Giuliano Anastasi Lisa Scaramozzino Michela Maccari Giulia Fattore Caterina Mercuri Maria Catone Francesco Gravante

Background/Objectives: Delirium is a frequent and clinically significant complication in cardiac surgery patients and is associated with prolonged mechanical ventilation, longer Intensive Care Unit (ICU) stay, increased mortality, and long-term cognitive impairment. However, evidence regarding perioperative factors associated with delirium occurrence in cardiac surgery ICU patients remains limited. This study aims to investigate clinical factors associated with postoperative delirium in cardiac surgery patients admitted to the ICU. Methods: A single-center, prospective, observational study was conducted in a 14-bed cardiothoracic ICU in central Italy. Consecutively enrolled adult patients undergoing cardiac surgery were assessed for delirium using the Italian-validated Intensive Care Delirium Screening Checklist (ICDSC) every eight hours for five days. Univariate analysis and multivariate logistic regression were performed to identify factors associated with delirium occurrence. Results: A total of 175 patients were included, and delirium occurred in 44.6%. In the univariate analysis, patients with delirium presented significantly longer mechanical ventilation (10.5 vs. 8.0 h; p = 0.04) and higher APACHE II scores (p = 0.01). In the multivariable analysis, lower Glasgow Coma Scale (GCS) scores were independently associated with delirium occurrence (OR = 0.84; 95% CI: 0.71–0.99; p = 0.04). Urgent admission (OR = 2.02; p = 0.06) and mean arterial pressure (OR = 0.97; p = 0.08) did not reach statistical significance in the multivariable model. Conclusions: Delirium is highly prevalent after cardiac surgery. Lower postoperative GCS scores may represent an early marker of postoperative neurological vulnerability associated with delirium occurrence. Further multicenter studies are warranted to improve delirium risk stratification and clarify the mechanisms underlying postoperative cognitive dysfunction.

Nursing Reports doi: 10.3390/nursrep16060183

Authors: Cânia Torres Francisco Mendes Paula Duarte Maria Barbieri-Figueiredo

Background: Sustained implementation of evidence-based practice (EBP) remains a challenge in complex clinical environments. Structured knowledge translation frameworks, such as the Knowledge-to-Action model (KTA), have been proposed to facilitate integration of evidence into care. However, less is known about how nurses experience the consolidation of KTA-guided implementation in clinical practice. This study aimed to explore nurses’ experiences of changes in clinical practice and professional development following consolidation of KTA guided implementation in a pediatric inpatient unit. Methods: A qualitative descriptive study was conducted using two focus groups with 20 pediatric nurses who had participated in the implementation process. One year after consolidation of the implementation process, data were collected via videoconference using a semi-structured interview guide and analyzed through thematic content analysis following Bardin’s methodological framework. Results: Four themes emerged: (1) contribution of the KTA to the clinical context; (2) influence on EBP competencies; (3) impact on professional development; and (4) sustainability within the organizational context. The implementation was experienced as a shift in care philosophy, with evidence becoming central to clinical reasoning, team alignment, and service structures. Conclusions: Participants perceived that the implementation of the KTA framework extended beyond competence development, influencing clinical practice, professional interactions, and organizational routines within the unit. Sustainability was associated with contextual adaptation, leadership alignment, and structural integration of evidence-based practices into care. These findings contribute to understanding mechanisms supporting durable EBP implementation in pediatric settings.

Nursing Reports doi: 10.3390/nursrep16060182

Authors: Shuling Wei Wei Wei

Background: Providing effective peer feedback is a challenge in nursing education. While Generative AI (GenAI) can assist, students often struggle with the task. Metacognitive scaffolding may help guide students through this complex process. Aim: This study aimed to evaluate the effects of a metacognitive scaffolding-based GenAI-assisted peer feedback provision (MGPFP) approach on nursing students’ feedback engagement and behavioral patterns. Methods: A quasi-experimental study was conducted with 71 nursing students. The experimental group (n = 35) used the MGPFP approach, while the control group (n = 36) used a standard GenAI-assisted approach without scaffolding. A Mann–Whitney U test was used to compare feedback engagement. Lag sequential analysis was used to examine feedback giving behavior patterns based on coded video data. Results: The experimental group reported significantly higher engagement than the control group across four dimensions: behavioral, cognitive, social, and emotional engagement. The experimental group generated 5219 coded behaviors, while the control group generated 1861. In the experimental group, common behaviors included referring external resources (19.58%), comparing and making judgements (17.80%), and recognizing the purpose (15.77%). Non-feedback behaviors were much higher in the control group (2.69%). Lag sequential analysis identified 17 significant sequences in the experimental group and 14 in the control group. Conclusions: Integrating metacognitive scaffolding into GenAI-assisted peer feedback can improve nursing students’ engagement and promote more productive and structured feedback behaviors. This approach is a valuable strategy for enhancing the quality of peer feedback in nursing education.

Nursing Reports doi: 10.3390/nursrep16060181

Authors: Glòria Tort-Nasarre Alícia Baltasar-Bagué Maria del Carmen Malagón-Aguilera Mariona Vilar-Pont Carla Camí Glòria Reig-Garcia

Background: The expansion of telenursing in primary care requires undergraduate nursing programmes to prepare students for clinical decision making in virtual care. However, evidence on educational interventions integrating clinical reasoning with managing uncertainty, anxiety, and self-confidence in telenursing remains limited. Objective: This study aims to assess changes in nursing students’ self-confidence and anxiety related to clinical decision making following a simulation-based video consultation intervention, and to explore their satisfaction and perceived learning regarding this educational experience. Methods: A quasi-experimental pretest–post-test study with a comparison group was conducted at two public universities during the 2024–2025 academic year. Undergraduate nursing students (N = 115) were included. The intervention consisted of theoretical training on video consultations, complemented by structured simulated consultations based on primary care scenarios. The control group received no intervention. Outcomes were assessed before and after, with self-confidence and anxiety measured using the Nursing Anxiety and Self-Confidence with Clinical Decision Making (NASC-CDM©) scale. Satisfaction and perceived learning were evaluated in the intervention group using the Student Satisfaction and Self-Confidence in Learning Scale. Results: At baseline, students had high digital competence but limited preparedness for telenursing, with heterogeneous self-confidence and moderate anxiety in virtual decision making. After the intervention, the intervention group showed significant increases in self-confidence and reductions in anxiety, particularly in global clinical judgement and autonomous decision making. Students reported high satisfaction and perceived learning. Conclusions: Simulation-based video consultations may improve nursing students’ self-confidence and reduce anxiety in virtual care decision making, suggesting a potentially valuable strategy for integrating psychoeducational dimensions into nursing curricula on digital health.

Nursing Reports doi: 10.3390/nursrep16060180

Authors: Marco Di Nitto Paolo Landa Paolo Iovino Rosaria Alvaro Alessandra Burgio Valeria Caponnetto Stefano Domenico Cicala Giancarlo Cicolini Manuele Cesare Loreto Lancia Duilio Fiorenzo Manara Ilaria Marcomini Beatrice Mazzoleni Alvisa Palese Laura Rasero Gennaro Rocco Francesco Zaghini Loredana Sasso Annamaria Bagnasco

Background/Objectives. Country-level evidence on the economic footprint of home care nursing is still scarce, particularly in systems where tariffs for community-based nursing are lacking. In Italy, recent laws have expanded home care; yet planning and funding remain constrained by the absence of robust micro-costing evidence. Objectives. To estimate the accounting cost of home care nursing visits in Italy using a bottom-up micro-costing approach and to identify the main cost drivers influencing expenditure. Methods. A multicentre, cross-sectional study was conducted. Data were collected in two phases: (1) a national survey of 3949 home care nurses from 70 Local Health Authorities (April–October 2023), describing workload, travel time, and the most frequently performed activities; and (2) a time-and-motion study of 527 consecutive home visits performed by 83 nurses in three Local Health Authorities (March 2024). Direct costs were estimated from the Italian National Health Service perspective and included nursing time, travel time and transportation, back-office activities, and materials. Personnel costs were derived from national collective labour agreements and inflation-adjusted. A base-case scenario estimated accounting costs directly measured in the study. An extended, illustrative scenario explored the economic value of nursing activities by applying existing outpatient tariffs. Deterministic and probabilistic sensitivity analyses (10,000-iteration Monte Carlo simulation) were performed. Results. The mean accounting cost of home care nursing was €27.78 per patient per day. At the provider level, the corresponding daily cost per nurse was €190.00, assuming a mean caseload of 6.84 patients per nurse per shift. In the extended scenario, the imputed economic value of nursing activities increased the estimated daily cost to €120.81 per patient and €826.32 per nurse. Sensitivity analyses identified organizational factors (particularly the number of patients per shift and the number of activities per visit) as the dominant cost drivers, while material and transportation costs had a comparatively limited impact. Conclusions. Home care nursing in Italy appears to be delivered at a relatively low accounting cost, with organizational factors playing a greater role than unit prices in determining expenditure. The absence of a dedicated reimbursement framework for nursing activities may result in a substantial under-recognition of the economic value of home-based nursing care. These findings provide preliminary evidence to support workforce planning, reimbursement policies, and the sustainable development of territorial care services.

Nursing Reports doi: 10.3390/nursrep16060179

Authors: Juliana Choueiry Catherine Chong Stephanie Lemay James S. Hutchison Megan Greenough

Background: Nurse Practitioners (NPs) are increasingly integrated into pediatric inpatient teams in response to evolving healthcare needs and workforce challenges. However, evidence describing how NP roles are operationalized, implemented, and sustained in general pediatric ward settings remain fragmented. Objective: This scoping review will synthesize international literature on NP roles in general pediatric inpatient settings, with a focus on determinants of role implementation. Guided by the Participatory, Evidence-based, Patient-focused Process for Advanced Practice Nursing (PEPPA) framework, this review will examine implementation strategies, outcomes, timelines, facilitators, barriers, and required resources to inform future integration and evaluation. Methods: This scoping review will be conducted in accordance with Joanna Briggs Institute (JBI) methodology and reported following PRISMA-ScR guidelines. A PRESS-reviewed search strategy will be applied to Scopus, MEDLINE, PsycInfo, CINAHL, Cochrane Central, ProQuest, grey literature, and reference lists for English and French language studies published from 2016 onward. Studies relating to NP roles in general pediatric wards internationally will be included. Data extraction and synthesis will be structured using the PEPPA framework’s implementation domain. Findings will be summarized descriptively and presented in tables and narrative synthesis. Conclusions: A targeted synthesis focused on determinants of NP role implementation in this context is needed. This review will clarify how NPs roles have been integrated in general pediatric wards, highlight enabling and constraining factors, and will identify gaps to guide future research, practice redesign, and policy development.

Nursing Reports doi: 10.3390/nursrep16050178

Authors: Matthias Pilz Lydia Sterzenbach Annabell Albertz

Background/Objectives: Skilled labor migration of nurses from low- and middle-income to high-income countries is a growing global phenomenon. While Germany increasingly recruits internationally trained nurses to address severe nursing shortages, existing research has predominantly focused on post-migration experiences, leaving the pre-migration phase unexplored. Drawing on the case of Kerala, India, this study examines the motives driving Indian nurses to migrate to Germany during the preparatory phase of migration. Methods: The qualitative study draws on individual and group interviews with 22 Indian nurses from Kerala participating in a pre-migration preparatory course. Data were analyzed using qualitative content analysis, with Herzberg’s two-factor theory serving as a theoretical lens. Results: In total, the findings demonstrate that nurses’ decisions to migrate to Germany are shaped by a complex and interrelated set of motives encompassing personal fulfillment, socio-cultural aspirations and professional development. The intrinsic motivation to engage with a new language and culture emerged as a particularly salient finding, representing a dimension frequently overlooked in existing research. Applying Herzberg’s theory, migration decisions appear to result from an interplay of intrinsic motivators like career advancement and the perceived absence of fundamental extrinsic conditions such as adequate salary and social security in the country of origin. Conclusions: The findings have practical implications for practitioners, policymakers, employers and training providers. Preparatory programs could extend beyond language and professional training to include cultural preparation and realistic expectation management, while integration measures in Germany could be tailored to the actual needs and motives of internationally recruited nurses.

Nursing Reports doi: 10.3390/nursrep16050177

Authors: Rasha Kadri Ibrahim Noor Hafiz Saleem Ruba Mohd Salameh Amal Abdullah Alali Bushra Ali Alnaqbi Ahmed Yahya Ayoub

Aim: This study aimed to evaluate self-reported digital health literacy levels and work engagement among nurses in the United Arab Emirates (UAE), while also examining associations with demographic factors and the interplay between digital health literacy and work engagement. Background: The integration of digital technologies into healthcare has transformed patient care, clinical practice, and administration. Nurses, as frontline practitioners, play a crucial role in utilizing digital tools to enhance patient interactions and navigate complex healthcare systems. Methods: Between May and August of 2024, 364 nurses in the United Arab Emirates participated in a cross-sectional design study. A standardized 21-item self-reported Digital Health Literacy questionnaire and a 9-item Utrecht Work Engagement Scale were administered. Descriptive statistics were used, with t-tests, ANOVA, correlations, and multiple linear regression applied. Results: The average score for self-reported digital health literacy (3.05 ± 0.57) and work engagement (4.83 ± 1.13) was high. Gender, age, work experience, and education level showed varying patterns of association with self-reported DHL and work engagement across total and subscale scores. Education level was significantly associated with self-reported DHL but not with work engagement. The overall work engagement score and its subscales were positively correlated with self-reported DHL. Conclusions: Our findings provide a robust basis for subsequent research on DHL and work engagement. These findings support the relevance of self-reported DHL as a factor associated with nurses’ work engagement in digitally intensive healthcare settings. The study reveals that nurses reported high levels of digital health literacy and work engagement.

Nursing Reports doi: 10.3390/nursrep16050176

Authors: Anne Kristin Snibsøer Christin Thompson Venke Klubben Prytz

Background: The flipped classroom is an innovative student-centered teaching approach frequently applied in nursing education. The success of the approach relies on students coming prepared to class. Faculties play a critical role in facilitating students’ pre-class preparation. Objective: The objective of this study was to elicit nursing students’ preferred designs for pre-class preparation in large-group, flipped-classroom teaching in evidence-based practice, and to use these insights to inform practical, faculty-driven changes to course design and delivery. Methods: An action research study was conducted among bachelor’s students in nursing at a Norwegian university college. Data were collected through questionnaires with closed and open-ended questions, focus group interviews, and class meetings. Descriptive statistics and thematic analysis were applied to analyze data. Data were analyzed sequentially, and findings provided guidance for further actions. Results: The action was carried out and evaluated in two cohorts. The thematic analysis revealed one main theme—students need motivation for pre-class preparation—and three associated sub-themes: (1) Information: Communicate relevance and provide timely reminders, (2) Organization: Learning platform and workload, and (3) Engage learners: Diverse, interactive and aligned learning activities. Conclusions: Faculties can support motivation through clear communication of relevance, a well-organized learning platform, activating pre-class activities, and timely reminders. Successfully accommodating pre-class preparation for large-group teaching also appears to require coordinated faculty engagement and a shared commitment to student-centered approaches. Further evaluation is needed to determine which specific configurations work best in different contexts.

Nursing Reports doi: 10.3390/nursrep16050175

Authors: Tina Košanski Marijana Neuberg Mateja Križaj Grabant Tomislav Meštrović

Background: Specialized palliative care requires nursing professionals to address the complex physical, psychological, social and spiritual needs of patients with advanced incurable illness. This study aimed to assess the perceived adequacy of formal educational preparation among nurses working in specialized palliative care services in the Republic of Croatia and examine its association with self-assessed knowledge and the perceived need for additional education. Methods: A nationwide cross-sectional survey was conducted among nursing professionals employed in specialized palliative care services across Croatia. Data were collected using a structured questionnaire assessing sociodemographic characteristics, perceived adequacy of formal education, self-assessed knowledge, as well as the need for additional education in physical, psychological, social and spiritual care domains. An Educational Sufficiency Discrepancy Index (ESDI) was calculated to quantify the difference between perceived educational sufficiency and continuing education needs. For inferential statistics significance was set at p < 0.05 (two-tailed). Results: Among the 194 nursing professionals who participated in the study, perceived educational sufficiency was highest in the physical domain (87.5%), where it exceeded the reported need for additional education (31.6%). Negative discrepancies were observed in social (−12.9) and spiritual care (−17.6), indicating perceived educational deficits. Representation of physical care content in formal education was significantly associated with higher self-assessed knowledge across several domains (physical p < 0.001; psychological p = 0.008; social p < 0.001; spiritual p = 0.008). No significant associations were found between self-assessed knowledge and age, work experience or level of education. Conclusions: Formal nursing education alone may not fully meet the multidimensional competency requirements of specialized palliative care practice. Strengthening structured continuing professional development, particularly in psychosocial and spiritual care, may support holistic palliative care delivery and sustained professional competence.

Nursing Reports doi: 10.3390/nursrep16050174

Authors: Hugo Rosado Patrícia Motta Ana Cruz-Ferreira Catarina Pereira

Background/Objectives: Dance-based programs have been shown to support psychological well-being in later life, yet evidence remains limited for dance-mediated psychomotor interventions. This study examined the effects of a 12-week creative-dance-mediated psychomotor intervention on life satisfaction and positive and negative affect in community-dwelling older adults. Methods: This 12-week non-randomized controlled trial involved 34 participants (74.6 ± 6.6 years), allocated by convenience to an experimental group (EG) or control group (CG). The EG participated in a creative-dance-mediated psychomotor intervention (3×/week; 60 min/session; 36 sessions), while the CG maintained usual daily activities. Life satisfaction was assessed using the Satisfaction With Life Scale (SWLS), and affective experience was assessed using the Positive and Negative Affect Schedule (PANAS) at baseline and post-intervention. Results: No adverse events occurred; attendance was 89.8%. Within-group comparisons showed significant improvements in the EG for SWLS (20.4%), PANAS positive affect (14.3%), and PANAS negative affect (−13.9%), p < 0.05. In the CG, a significant improvement was observed only for PANAS negative affect (−11.5%), p < 0.05. Post-intervention comparisons between groups revealed significant differences favoring the EG for SWLS (p = 0.018) and PANAS positive affect (p < 0.001), with no significant between-group differences at baseline. Conclusions: Over 12 weeks, the intervention was associated with higher life satisfaction and positive affect in the EG compared with the CG. These findings suggest that this intervention format is safe and feasible and may support psychological well-being in community-dwelling older adults.

Nursing Reports doi: 10.3390/nursrep16050173

Authors: Rui Novais Cláudia Rodrigues Fátima Braga Rui Pereira Carlos Sequeira Núria Albacar-Riobóo Silvana Martins Odete Araújo

Background: Population ageing has increased the number of older adults living in nursing homes, where loneliness and sleep disturbances are prevalent and negatively affect well-being. Evidence suggests a bidirectional relationship between loneliness and sleep quality, although research in institutionalised populations remains limited. Objectives: This study aimed to characterise the sociodemographic and health profile of nursing home residents in Northern Portugal and examine associations between sleep quality, loneliness, sociodemographic and health variables. Methods: A cross-sectional study was conducted with 157 older adults (≥65 years) across 13 nursing homes. Data were collected using a sociodemographic questionnaire and the Portuguese version of UCLA Loneliness Scale, Pittsburgh Sleep Quality Index and Montreal Cognitive Assessment. Pearson correlations and hierarchical multiple regression analyses were performed. Results: Participants were predominantly female (72.6%), widowed (55.4%), and aged ≥80 years. Most reported chronic conditions (98.7%) and limitations in activities of daily living (75.2%). Age showed modest positive correlations with loneliness. Loneliness dimensions were strongly associated with poorer sleep quality and greater daytime dysfunction. Hierarchical regression revealed that sociodemographic variables explained only a small proportion of variance in sleep quality. The addition of loneliness variables increased explained variance to 38.1%, highlighting loneliness as a key psychosocial predictor. Conclusions: Loneliness significantly influences sleep quality among older adults living in nursing homes. Interventions should integrate strategies to enhance social engagement alongside sleep hygiene measures. Longitudinal studies are recommended to clarify causal pathways.

Nursing Reports doi: 10.3390/nursrep16050172

Authors: Valentina Cerrone Rocco Capasso Marco Cascella Ivan Rubbi Anna Di Gisi Pierpaolo Di Santo Vincenzo Andretta

Background/Objectives: Caregiver burden is a relevant dimension of the caregiving experience among informal caregivers of cancer patients and is associated with psychological, physical, and social consequences. Although several instruments are available to assess the phenomenon, there is still limited consistency in the tools used across empirical oncology studies. Methods: A systematic review was conducted according to the PRISMA 2020 statement. A literature search was carried out in PubMed, Scopus, Web of Science, CINAHL, and PsycINFO up to February 2026. Quantitative studies assessing caregiver burden using standardized instruments in informal caregivers of adult cancer patients were included. Results: Thirteen studies met the eligibility criteria. The most frequently used instruments were the Zarit Burden Interview, followed by the Caregiver Burden Inventory. Less frequently used instruments included the Caregiver Reaction Assessment and the Caregiver Burden Scale. Most included studies relied on generic caregiver burden instruments originally developed outside oncology-specific contexts. Conclusions: Considerable heterogeneity exists in the instruments used to assess caregiver burden in oncology research. Empirical studies continue to rely predominantly on generic caregiver burden scales, while oncology-specific tools appear to be underused. Greater consistency in instrument selection may improve comparability across studies and support the integration of caregiver assessment into oncology practice.

Nursing Reports doi: 10.3390/nursrep16050171

Authors: Paola Guzmán-De Santa Ana Alexis Serna-Menor Ana Martínez-García Raquel Moreno-Sánchez Carlos Ruíz-Núñez Andrés Ignacio García-Notario Juan Pablo Hervás-Pérez Ivan Herrera-Peco

Introduction: Humanized care is a core indicator of nursing quality, yet its prevalence and determinants among Spanish undergraduates remain unclear. Methods: A cross-sectional survey was administered to fourth-year nursing students from public and private universities. Instruments included the Health Professional’s Humanization Scale (HUMAS), the Communication Styles Inventory-Revised (CSI-R) and a sociodemographic questionnaire that captured prior training: completion of ≥6 h role-playing seminars in patient–family communication. Results: Mean scores were 3.62 ± 0.48 for HUMAS and 2.50 ± 0.52 for CSI-R. Women exceeded men on HUMAS total (p = 0.025) and on Sociability, Emotional Understanding, Dispositional Optimism and Self-Efficacy (all p ≤ 0.013), but not on Affect-Regulation or CSI-R. Age correlated weakly with Optimism (r = 0.24) and Self-Efficacy (r = 0.21). Students who had completed the role-playing seminars recorded higher HUMAS totals (d = 0.50; p = 0.001) and sub-scores, with only a modest gain in Affect-Regulation, and showed a trend towards better CSI-R performance (p = 0.06). No differences emerged by university type. HUMAS and CSI-R correlated moderately (r = 0.32; p = 0.001). In multivariate analysis, training (β = 0.36; p = 0.001) and CSI-R (β = 0.26; p = 0.001) jointly explained 27.9% of humanization variance; male sex exerted a small negative effect (β = −0.19; p = 0.001), whereas age was nonsignificant. Conclusions: Structured communication seminars are a key factor associated with higher levels of humanization in senior nursing students, whereas sociodemographic influences are modest. Embedding longitudinal, simulation-rich modules in communication and emotional intelligence is therefore recommended to cultivate truly person-centered nurses and to narrow observed sex disparities.

Nursing Reports doi: 10.3390/nursrep16050170

Authors: Ziqiu Guo Tzu Tsun Luk Xue Weng Jung Jae Lee Yongda Wu Shengzhi Zhao Derek Yee Tak Cheung Agnes Yuen Kwan Lai Henry Sau Chai Tong Vienna Wai Yin Lai Tai Hing Lam Man Ping Wang

Objectives: To explore the experiences of ex-smokers acting as peer supporters delivering chat-based instant messaging smoking cessation support in a post- randomized controlled trial qualitative study. Methods: We used purposive sampling to recruit 21 ex-smokers, who had previously provided chat-based instant messaging behavioral support to smokers in Hong Kong. Individual online semi-structured interviews were conducted. All interviews were audiotaped and transcribed verbatim. The transcripts were analyzed using inductive thematic analysis following Braun and Clarke’s six-phase framework. Results: Five themes were identified: stepping into the supporter role as ex-smokers, contributions beyond facilitating smoking cessation, mutual benefits as ex-smoking peer supporters, challenges in providing support, and the potential of mobile health-based peer support. Participants identified experiential sharing as a key mechanism for engaging motivated smokers, although its impact was limited by low user responsiveness. They described extending their support beyond smoking cessation (e.g., stress relief and healthier lifestyles), and reported mutual benefits, such as enhanced happiness, a positive attitude, and prevention of smoking relapse. Nevertheless, participants’ ability to effectively support smoking was challenged by limited interaction in the mHealth setting, difficulties offering timely responses, and uncertainty about how to handle complex personal situations. They suggested that future mobile health peer support can consider involving famous people as peer supporters, using personalized messaging, and adding incentives in the program to increase smokers’ motivation. Conclusions: Ex-smoking peer support in mHealth settings appears feasible and mutually beneficial, but its effectiveness may be constrained by low engagement and unclear role expectations.

Nursing Reports doi: 10.3390/nursrep16050169

Authors: Marin Mamić Ivana Mamić Nikolina Farčić Robert Lovrić Ivana Barać Željko Mudri Marija Barišić Željka Dujmić Zrinka Puharić Ivan Vukoja

Introduction/Objective: Patient satisfaction with nursing care quality is an important patient-reported indicator of hospitalization experience. Previous studies have mainly examined sociodemographic, clinical, and organizational factors, while personality traits have rarely been included in explanatory models. This study examined the association of sociodemographic characteristics, hospitalization-related variables, and personality traits with patient satisfaction. Methods: A single-center cross-sectional study was conducted among hospitalized patients in a general hospital in Croatia. Data were collected at discharge using a demographic and hospitalization questionnaire, the NEO Five-Factor Inventory, and the Croatian version of the Patient Satisfaction with Nursing Care Quality Questionnaire. Group differences were analyzed using non-parametric tests, and hierarchical regression analysis was performed. Results: Younger age, employment, male gender, and better self-rated health were associated with higher satisfaction. Patients admitted on a scheduled basis and those staying alone or with one other person in the room were more satisfied. Sociodemographic variables explained 21.5% of the variance in satisfaction (R2 = 0.215; adjusted R2 = 0.168). After hospitalization-related variables were added, the explained variance increased to 30.1% (R2 = 0.301; adjusted R2 = 0.232). The addition of personality traits further increased the explained variance to 45.6% (R2 = 0.456; adjusted R2 = 0.385). In the final model, staying with two or more persons was negatively associated with satisfaction, whereas agreeableness and conscientiousness were positively associated with satisfaction. Conclusions: Patient satisfaction with nursing care quality was associated with patient characteristics, hospitalization conditions, and personality traits. Accommodation conditions and individual psychological differences should be considered when interpreting satisfaction as an indicator of nursing care quality.

Nursing Reports doi: 10.3390/nursrep16050168

Authors: Lucília Nunes Andreia Ferreri Cerqueira Ana Poeira

The organized integration of research competencies into nursing curricula is still a global challenge and is key for preparing professionals to respond to complex clinical contexts, technological advancements, and contemporary societal demands. At the School of Health of the Polytechnic Institute of Setúbal, a longitudinal research axis was implemented across the four years of the undergraduate nursing program, involving epistemological foundations, the research process, evidence-based practice, and applied practice. Objective: The objective of this study was to describe the design and implementation of the longitudinal axis of research, analyzing institutional indicators of academic success and the progressive development of students’ scientific competencies. Methods: A descriptive documentary study based on institutional data analysis (the number of enrolled students, pass rates, and mean grades in the four research-related curricular units) was conducted, complemented by a review of pedagogical materials produced (two published course booklets: “Research I—From the origin to the dissemination of knowledge” and “Research II—(De)Constructing the Research Process: A Critical and Practical Analysis”) and evidence of scientific dissemination (conference presentations and published articles). Results: A continuous progression in academic performance was observed across the research curricular units, accompanied by increased complexity of student work and enhanced scientific literacy. The sequential structure proved essential: the articulation of epistemology, methodology, critical appraisal, and scientific production demonstrated strong coherence and pedagogical efficiency. Conclusions: The longitudinal research axis constitutes a curricular innovation that strengthens essential scientific competencies in undergraduate nursing education. Longitudinal models that reflect both conceptual and practical progression can significantly contribute to the development of nurses who are critical thinkers, reflective practitioners, and capable of integrating evidence into clinical decision-making.

Nursing Reports doi: 10.3390/nursrep16050167

Authors: Samantha Ruth Novales-Huidobro Maria Lorena Ángeles-Pacheco Misato González-Kawahara Natalia Constantino-Segura Paula García-Olea Reyna Sámano Gabriela Chico-Barba

Background: Violence in healthcare settings affects nursing students during clinical training and may compromise their mental well-being, learning experiences, and professional development. Despite evidence from high-income countries, limited data exist on how contextual and organizational factors in Latin American settings shape these experiences. This study aimed to assess the frequency and types of violence experienced by nursing students during clinical practice and the academic and emotional consequences. Methods: Cross-sectional study conducted among undergraduate and graduate nursing students in Mexico City who had completed at least one hospital-based clinical placement in the previous 12 months. Data were collected between January 2024 and September 2025 using a validated questionnaire assessing types of violence, perpetrators, academic and emotional consequences. Violence was defined as experiencing events “occasionally,” “sometimes,” or “frequently.” Descriptive statistics were calculated. Associations were examined using Pearson’s chi-square test, and logistic regression models adjusted for age, sex, and year of study. Results: Seventy-three students participated (86.3% female). Non-physical violence was the most frequent type (90.4%), followed by sexual harassment (49.3%), mainly perpetrated by nurses (62%) and physicians (46.5%). Considering leaving the profession (41.4%) and feelings of inadequacy (66.2%) were the most common academic and emotional consequences. Although some associations were observed in bivariate analyses, these were not significant after adjustment. Conclusions: Violence during clinical training is highly prevalent and may represent a significant threat to nursing students’ mental well-being and professional development. Strengthening institutional policies, reporting mechanisms, and supportive learning environments is essential to mitigate its impact and promote safer clinical training.

Nursing Reports doi: 10.3390/nursrep16050166

Authors: Mario Marendić Ajka Pribisalić Ivana Bokan Ivana Parčina Silvija Vladislavić Mario Podrug Ante Buljubašić Anamarija Jurčev Savičević

Background: Nursing students are at high risk of exposure to blood and body fluids due to limited clinical experience. Ensuring adequate knowledge and proper post-exposure protocols is vital for improving safety and post-exposure management. Aim: This study aimed to evaluate the level of knowledge, previous exposure experience, and reporting practices regarding occupational exposure incidents among nursing students at the Faculty of Health Sciences, University of Split, Croatia. Methods: A cross-sectional study was conducted among 274 nursing students using a structured self-administered questionnaire. Descriptive statistical methods were applied, along with univariate and multivariate linear regression analyses. Results: Exposure incidents were experienced by 36.3% of students, with needlestick injuries being the most common (80.1%). In terms of reporting practices, fewer than half (40.8%) of those affected officially reported the incident. While students demonstrated adequate overall performance on the knowledge assessment (median score 12, IQR: 11–14), significant gaps were identified in hepatitis B and C protocols and immediate wound care. Multivariate analysis identified full-time student status (β = 1.24; p = 0.010) and first-year students (β = 0.82; p = 0.036) as factors significantly associated with higher knowledge scores. Conclusions: Although nursing students possess solid fundamental knowledge of exposure-related risks, a significant gap remains in their practical application and incident reporting. The high incidence of needlestick injuries (80.1%) underscores the importance of moving beyond theory toward enhanced clinical supervision. To address these gaps, nursing education should prioritize targeted practical training and cultivate a robust safety culture that encourages incident reporting.

Nursing Reports doi: 10.3390/nursrep16050165

Authors: Carlo Alberto Camuccio Paola Tiatto Orejeta Diamanti Elisabetta Bisinella Rachele Loro Alice Bernardi Martina Berto Federica Turchet Andrea Rostirolla Elena Reginato Shabnam Zohrabi Weisha Qi Matteo Bernardi

Background/Objectives: The placement of central venous access devices, including peripherally inserted central catheters (PICCs) and PICC-PORTs, is a routine procedure in oncology care. Usually associated with limited physical pain, these procedures may nevertheless generate significant anxiety and negatively influence the overall procedural experience. Virtual reality (VR) has emerged as a non-pharmacological intervention capable of modulating attentional and emotional responses during medical procedures; however, evidence in adult oncology patients undergoing vascular access placement remains scarce. The aim of this study is to evaluate the effect of VR on an oncological patient’s overall procedural experience. Methods: This manuscript outlines the design and methodology of a prospective, single-centre randomised controlled trial. Adult oncology patients scheduled for PICC/PICC-PORT placement are randomised to receive standard care alone or standard care combined with an immersive VR intervention delivered via a head-mounted display during the procedure under pragmatic, real-world clinical conditions. The primary outcome is a composite patient-reported procedural experience endpoint, assessed through a non-aggregated framework encompassing procedural anxiety, comfort, satisfaction and procedural tolerability. Procedural anxiety constitutes the main quantitative driver; the remaining domains are analysed as individual component dimensions and interpreted jointly to contextualise the overall experience. Secondary outcomes include procedural pain, physiological parameters and procedural characteristics. A mixed-methods approach integrates quantitative assessment with qualitative phenomenological analysis. Results: The study is expected to provide methodological and clinical insight into the role of immersive VR in improving procedural experience and support future multicentre trials. Conclusions: This trial will contribute to the expanding field of digital and immersive health technologies by evaluating VR as a patient-centred adjunct intervention in oncological procedural care using a predefined patient-reported experience-based primary endpoint. The protocol has been submitted to ClinicalTrials.gov with the registration number NCT07384741.

Nursing Reports doi: 10.3390/nursrep16050164

Authors: Olinda Monsanto António Nunes Ana João

Background: Nurses’ job satisfaction is an important factor associated with motivation, retention, and performance, potentially influencing the quality and safety of healthcare delivery. Identifying organizational and professional determinants of job satisfaction is essential for the sustainability of healthcare systems. Objective: This study aims to describe nurses’ job satisfaction across its multiple dimensions and examine differences in job satisfaction dimensions across sociodemographic and professional groups. Methods: A quantitative, cross-sectional, descriptive–correlational study was conducted with 153 nurses. Data were collected between October and December 2024 using an online questionnaire, with a response rate of 28.9%, which included the Escala de Satisfação dos Enfermeiros com o Trabalho (ESET). Descriptive and inferential statistical analyses were performed, with the significance level set at 0.05. Results: Moderate levels of job satisfaction predominated among participants (75.8%), with 5.2% of participants reporting low satisfaction. The highest mean scores were observed in satisfaction with co-workers and professional recognition, while the lowest scores were found in the recognition and remuneration dimension. Statistically significant differences in mean job satisfaction scores were observed across groups defined by variables such as work setting, work schedule, weekly workload, and employment across multiple workplaces. Conclusions: Nurses’ job satisfaction is multidimensional and varies across different professional and organizational groups. These findings highlight areas of lower job satisfaction that may represent priorities for future organizational assessment and management attention.

Nursing Reports doi: 10.3390/nursrep16050163

Authors: Marcello Torre Cristina Arrigoni Rosario Caruso Antonio Maria Giuseppe Staffa Desiree Lucà Arianna Magon

Background/Objectives: Nurse transition programmes are widely implemented to support newly hired nurses and promote workforce retention. Despite the growing number of published reviews, conceptual inconsistency and methodological heterogeneity limit the interpretability and cumulative value of the evidence. This umbrella review aimed to synthesise and critically examine review-level evidence on nurse transition programmes, clarifying programme typologies, contexts, methodological approaches, reported outcomes, and thematic patterns. Methods: An umbrella review was conducted in accordance with PRISMA 2020 guidance. Systematic searches were performed in CINAHL, PubMed, Scopus, Web of Science, and Google Scholar, supplemented by citation tracking. Results: Fourteen reviews published between 2010 and 2025 were included: 12 reviews of primary studies and two reviews of secondary evidence (one umbrella review and one meta-review). Programme models and outcome measures were highly heterogeneous, and primary study overlap was slight (CCA = 2.55), indicating that reviews in the corpus drew on largely non-overlapping sets of primary studies. Transition programmes for new nurses commonly use one-on-one preceptorships with supernumerary practice, simulation-based learning, and active methods like case studies and reflective journaling to build competence and confidence. Their duration varies from a few days to 12 months, aligning with the progressive learning curve of new graduates. Professional outcomes, particularly competence and confidence, were consistently reported, whereas organisational outcomes, such as retention, showed mixed, methodologically constrained evidence. Patient-level outcomes were rarely examined. Thematic analysis revealed a shift over time from individual professional readiness towards implementation and organisational considerations. Conclusions: Given this conceptual plurality, there is an urgent need to standardise key indicators for evaluating the effectiveness of nurse transition programmes across healthcare settings globally.

Nursing Reports doi: 10.3390/nursrep16050162

Authors: Petra Zuborova Alica Slamkova Milos Mlyncek Jozef Visnovsky Jan Bujnak Pavol Zubor

Objectives: This study sought to assess quality of life (QoL) in Slovak breast cancer survivors and examine its association with treatment modalities and sociodemographic factors. Methods: This cross-sectional observational study included 244 Slovak female breast cancer survivors (stages IA–IIIC). Participants were aged 25–85 years, ECOG 1–2, without synchronous malignancies or severe comorbidities. Data were collected using the EORTC QLQ-C30 and breast cancer-specific module. Results: Mean global health status/QoL indicated a moderate QoL level (51.67). Emotional and cognitive functioning were relatively preserved, whereas social and role functioning were more impaired. The most prominent symptoms included insomnia, fatigue, dyspnoea, and pain. Breast cancer-specific domains showed relatively high body image scores but marked impairment in sexual activity and future perspective. Severe symptoms included hair loss, upper limb problems and systemic side effects of therapy. Significant differences were observed across functional domains and symptoms (p < 0.001). Chemotherapy was associated with better role functioning (p = 0.011), lower pain (p = 0.043) and insomnia (p = 0.012), but also with higher levels of hair loss (p = 0.003); however, these findings should be interpreted with caution due to potential confounding factors. Radiotherapy was associated with higher social functioning, body image and future perspective (p = 0.007 for all), but also with increased breast symptom severity (p = 0.044). Sociodemographic factors, particularly place of residence and education level, were significantly associated with overall QoL. Conclusions: Slovak breast cancer survivors report moderate overall QoL, with emotional and cognitive functioning relatively preserved, but social, role and sexual domains impaired. Treatment modalities and sociodemographic factors are associated with differences in specific QoL domains, highlighting the need for targeted, context-sensitive supportive care. The findings also underscore the importance of oncology nursing in survivorship care, particularly in addressing physical, social and sexual domains and key symptoms such as insomnia, fatigue and pain. Targeted psychosocial and educational support, along with culturally sensitive QoL assessment, may help improve patient-centred outcomes in breast cancer survivors in Central and Eastern Europe.

Nursing Reports doi: 10.3390/nursrep16050161

Authors: Blerina Duka Kejda Nuhu Fabiola Mane Jola Çini Armela Zylfo Kujtime Vakeflliu Alta Arapi

Background/Objectives: The rapid expansion of telemedicine has reshaped healthcare delivery, positioning telenursing as essential for continuity of care and patient management. This scoping review maps current evidence on telecare nursing practices, examining organizational models, professional roles, and key clinical and organizational outcomes. Methods: The review was conducted across five international databases, following the methodological framework proposed by Arksey and O’Malley, the interpretive extension by Levac et al., and the Joanna Briggs Institute guidelines, with reporting aligned to PRISMA-ScR recommendations. The search identified 1760 records, of which 1219 remained after duplicate removal. After title and abstract screening and full-text evaluation, 25 studies met the inclusion criteria. Results: Telenursing was implemented across diverse clinical contexts, particularly in chronic disease management, oncology, postoperative care, and emergency settings. Evidence indicates improvements in symptom management, therapeutic adherence, quality of life, and complication reduction, suggesting positive clinical and organizational impacts. The literature highlights the need for advanced digital, communication, and relational competencies, emphasizing the importance of targeted professional training. Cross-cutting trends include enhanced continuity of care, greater patient autonomy, improved integration between hospital and community services, and reduced healthcare costs. Conclusions: This review provides an updated overview of telenursing applications, highlighting their adaptability across clinical settings and the expanding strategic role of nurses in digital care. The findings indicate a rapidly evolving field and emphasize the need for further research to strengthen organizational frameworks, define advanced competencies, and support the sustainable integration of telenursing into healthcare systems.

Nursing Reports doi: 10.3390/nursrep16050160

Authors: Amelina de Brito Belchior Victória Maria Silva Leitão Thiago Martins de Sousa Lourival Veras de Oliveira Pablo Casimiro Belchior Rodrigues Florencia Gamileira Nascimento Sherida Karanini Paz de Oliveira

Objective: To test the factorial structure and reliability of the Brazilian version of the Diabetic Foot Self-Care Questionnaire of the University of Malaga-Spain (DFSQ-UMA-Br). Method: Cross-sectional study for psychometric evaluation of the DFSQ-UMA-Br conducted with 269 people with diabetes who responded to the items of the collection instrument composed of sociodemographic and clinical data and the tested instrument, from February 2024 to February 2025. The internal structure was evaluated using Exploratory and Confirmatory Factor Analysis. Reliability was assessed using Cronbach’s alpha and McDonald’s omega. Results: The factor analysis for the DFSQ-UMA-Br data matrix was adequate (KMO = 0.79 [95% CI] = 0.71–0.82]); Bartlett’s sphericity test = p < 0.001; degree of freedom of 66), indicating that the variables are correlated. Psychometric sensitivity with adequate values of asymmetry (sk = 0.199–3.655) and kurtosis (ku = −0.226–+3.764) proving the normal distribution of data. Conclusions: The DFSQ-UMA-Br is a valid and reliable instrument capable of assessing foot self-care in people with diabetes in the Brazilian population and can be used by nurses and other professionals to promote health in the context of clinical care and research.

Nursing Reports doi: 10.3390/nursrep16050159

Authors: Thaynara Helena Ribeiro e Silva Medeiros José de Ribamar Medeiros Lima Junior Conceição de Maria Pedrozo e Silva de Azevedo Larissa Di Leo Nogueira Costa Marisa Cristina Aranha Batista Francyelle Costa Moraes Rachel Melo Ribeiro Almir José Guimarães Gouveia Ana Hélia de Lima Sardinha Fernanda Costa Rosa Mayara Soares Cunha Leonel Lucas Smith de Mesquita Luciana Batalha Sena Sara Fiterman Lima Angela Falcai

Objective: To identify the predictors of weight gain in people living with HIV (PLHIV) using antiretroviral therapy (ART). Methods: Observational, analytical, cross-sectional study with a quantitative approach, with 186 participants followed up at a specialized HIV service. Sociodemographic, behavioral, clinical, and anthropometric data were collected. Associations between overweight and independent variables were assessed using chi-square and logistic regression analyses, adopting a significance level of p < 0.05. Results: Most participants were male (62.5%), aged between 40 and 49 years (33.2%). Overweight was prevalent in 70% of the sample, predominantly affecting males, sedentary individuals, and those with diabetes mellitus. There was a statistically significant association between overweight and age (p = 0.047), as well as with a diagnosis of diabetes (p = 0.029). Despite the high rate of viral suppression (97.3%), there was a prevalence of metabolic alterations, such as dyslipidemia and sedentary lifestyle. Conclusions: Weight gain in PLHIV in ART is associated with metabolic factors and age. The strategic role of health professionals in monitoring BMI, health education, and preventing unfavorable clinical outcomes, such as diabetes and cardiovascular diseases, is highlighted.

Nursing Reports doi: 10.3390/nursrep16050158

Authors: Eva M. Montoro-Ramírez Isabel M. López-Medina Daniel Puente-Fernández Laura Parra-Anguita

Introduction: Climate change is increasingly affecting the health of older people. This study aimed to determine the knowledge, skills, and attitudes of nurses and undergraduate nursing students regarding the effects of climate change on older people’s health. Material and Methods: A descriptive cross-sectional study was conducted between January and April 2024 with 708 participants (210 nurses and 498 undergraduate nursing students). The Nursing Competencies Questionnaire on Environmental Health of Older People (NCQ-OPEH) was used to assess environmental competencies. Descriptive values were calculated and interrelationships between knowledge, attitudes, and skills were analysed. Results: A total of 115 nurses (54.75%) and 185 students (37.15%) demonstrated good-excellent knowledge. Similarly, a higher percentage of nurses (50.77%) reported better perceived skills than students (42.52%). However, the majority of both samples (98.97% and 87.85%, respectively) had good to excellent attitudes. These differences were significant for knowledge (p < 0.001) and attitudes (p = 0.013) but not for skills (p = 0.054). Furthermore, a significant relationship was found between prior education on climate change and health and greater knowledge (p = 0.019) and skills (p = 0.027) among nurses and better skills and attitudes (p < 0.001 in both) among nursing students. Conclusions: Nurses have better environmental competencies than undergraduate nursing students. Therefore, it is important to include education on climate change and older people’s health to be included in the academic curriculum of university nursing degrees. Nurses also need to reinforce these competencies through specific educational programmes, ensuring that clinical practice effectively adopts an environmental health approach to the care of older people.

Nursing Reports doi: 10.3390/nursrep16050157

Authors: Mary Rose Arcedo Julie Flynn Daniel Terry

Background/Objectives: Anaesthetic nurses play a critical role during surgical procedures. However, research focusing on Australian anaesthetic nurses remains limited. While previous studies have identified inconsistencies in anaesthetic nurse education, the everyday experiences of these nurses have not been comprehensively examined. This study aimed to explore the barriers and enablers influencing anaesthetic nursing practice in Australia and to examine anaesthetic nurses’ views on their evolving roles and responsibilities. Methods: A hermeneutic phenomenological approach was employed to explore the lived experiences of Australian anaesthetic nurses. Semi-structured interviews were undertaken to enable in-depth exploration of participants’ experiences, thoughts, feelings, and beliefs. Participants were interviewed by telephone, videoconference, or in person. Data were transcribed verbatim into Microsoft Word and analysed using reflexive thematic analysis, informed by Gadamerian hermeneutics. Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines were followed. Results: Four overarching themes were identified, Culture, Education, Leadership, and Institution, each shaping anaesthetic nursing practice in distinct yet interrelated ways, with several subthemes emerging within each category. These interrelated factors contributed to perceptions of being undervalued, restricted career progression, and uncertainty regarding role sustainability. Conclusions: The findings highlight the need for enhanced support systems and system-level reform that addresses hierarchical power dynamics alongside standardised, context-specific education and training pathways. Addressing these interconnected issues is essential to better support anaesthetic nurses while ensuring competent, high-quality care is provided. Understanding the structural and cultural concerns underpinning anaesthetic nursing practice may inform the development of coherent curricula, visible nursing leadership, and clearer professional recognition and career pathways.

Nursing Reports doi: 10.3390/nursrep16050156

Authors: María José Ferreira Ana Laguía Gabriela Topa

Background/Objectives: Therapeutic communication is a core competency in mental health nursing, yet clinical placements often offer limited opportunities for undergraduate students to practise relational skills in a safe and structured way. Simulation, particularly when aligned with the Healthcare Simulation Standards of Best Practice™ (INACSL), may provide a useful context for fostering empathy, emotional presence, and professional communication. This study aimed to evaluate undergraduate nursing students’ satisfaction and self-confidence following participation in a standardised-patient simulation designed to address therapeutic relationship competencies. Methods: A descriptive cross-sectional study was conducted with 142 third-year nursing students at a public university. Participants completed two INACSL-aligned simulation encounters involving psychiatric scenarios that required therapeutic engagement. After the sessions, students completed a questionnaire based on the Student Satisfaction and Self-Confidence in Learning Scale, adapted to the context of the simulation. Data were analysed using descriptive statistics. Results: Students reported high levels of satisfaction and self-confidence following the simulation experience. Between 88.0% and 92.9% of participants agreed or strongly agreed with items related to realism, relevance, and motivation. High levels of agreement were also observed for items related to therapeutic communication, critical thinking (98.6%), clinical competence (95.8%), and teamwork (93.6%). Lower levels of agreement were found for the usefulness of video-based debriefing (61.9%) and the adequacy of material resources (57.1%), suggesting areas for improvement in future implementation. Conclusions: Standardised-patient simulation was positively evaluated by nursing students and was associated with high levels of satisfaction and self-confidence in learning. The findings suggest that this type of educational strategy may support students’ perceived development of therapeutic communication and relational skills in mental health nursing education. However, these results are based on self-reported data collected using an adapted measurement approach and should be interpreted with caution. Further research using validated instruments and performance-based measures is needed to assess competence development more directly.

Nursing Reports doi: 10.3390/nursrep16050155

Authors: Ali Ay Hülya Bulut

Background/Objectives: Peristomal skin complications are common among individuals with a stoma and are associated with decreased quality of life, increased healthcare costs, social isolation, and various other challenges. However, these complications can often be prevented through appropriate care, patient education, counseling, and follow-up. This quasi-experimental study aimed to evaluate the effectiveness of education based on Orem’s Self-Care Deficit Nursing Theory (SCDNT) in preventing peristomal skin complications. Methods: The study included 45 patients with newly formed stomas, allocated to an experimental group (n = 24) and a control group (n = 21) using a nonrandomized approach. Both groups received routine postoperative education, while the experimental group additionally received structured education, counseling, and follow-up based on SCDNT. Data were collected using the Patient Characteristics Form, Self-Care Agency Scale (SCAS), Stoma Quality of Life Scale (SQOL), Patient Outcomes Evaluation Form, and Patient Opinions Questionnaire. Results: Among the participants, 73.3% had undergone stoma surgery due to cancer, and 53.3% had an ileostomy. Peristomal skin complications were observed in 54.2% of patients in the experimental group and 95.2% in the control group (p < 0.05). The most frequently reported complications were irritant dermatitis (71.4%) and hyperplasia (22.7%). The mean recovery time was shorter in the experimental group (21 ± 12.95 days) compared to the control group (44.65 ± 23.56 days) (p < 0.05). Conclusions: SCDNT-based education, counseling, and follow-up may be associated with lower rates and shorter durations of peristomal skin complications and earlier patient engagement in self-care. However, these findings should be interpreted with caution due to the nonrandomized design, small sample size, and differences in follow-up intensity. Further randomized controlled studies are recommended to confirm these findings.

Nursing Reports doi: 10.3390/nursrep16050154

Authors: Awatif Alrasheeday Aeshah Abdulaziz ALhawsawi Bushra Alshammari Sameer A. Alkubati Wiem Aouicha Mohamed Ayoub Tlili Abdulhafith Alharbi Bahia Galal Siam Soha Mahmoud Badria Elamin Layla Alshammari Hajer I. Motakef Tahani Alkhammali Ahad Alanazi Fatimah Alshammari Huda Alshammari Ruqayyah Abdullah Almohammed Ruba Abdulaziz Alomran

Background/Objectives: Artificial intelligence (AI) is increasingly used in healthcare to support clinical decision-making, patient monitoring, and administrative tasks. Nurses are expected to work with these technologies. However, the evidence suggests that their knowledge and preparedness remain limited. As future healthcare providers, nursing students must be prepared to integrate AI into their practice. This study aimed to assess nursing students’ knowledge, attitudes, perceived benefits and risks, barriers, professional impact, and preparedness toward AI in healthcare. Methods: This cross-sectional descriptive study was conducted between April and July 2024 at the College of Nursing, University of Hail, Saudi Arabia. A convenience sample of 320 undergraduate nursing students completed an online structured questionnaire that assessed their demographics, knowledge, attitudes, perceived barriers, benefits, risks, professional impact, and preparedness. Data were analyzed using IBM SPSS version 27 with descriptive statistics. Inferential analyses, including independent t-tests and one-way ANOVA, were performed to examine differences between groups. Pearson’s correlation was used to identify correlations between the study variables. Statistical significance was set at p < 0.05. Results: Most students (79.7%) had poor AI knowledge, whereas 52.5% reported positive attitudes. Older students (≥24 years) and internship students showed significantly more positive attitudes (p < 0.001). Knowledge was weakly correlated with attitudes (r = 0.147), benefits (r = 0.222), and risks (r = 0.152). Attitudes were weakly positively correlated with benefits (r = 0.243) and negatively correlated with barriers (r = −0.219). Conclusions: Despite their positive attitudes, nursing students showed limited knowledge and preparedness. Integrating AI education and practical training into nursing curricula is therefore essential. These findings should be interpreted cautiously given the cross-sectional design, single-institution sampling, and reliance on self-reported measures, which may limit generalizability.

Nursing Reports doi: 10.3390/nursrep16050153

Authors: Misuzu Gregg Chifuyu Hayashi Masami Tamada

Background/Objectives: Effective information seeking is essential for new graduate nurses’ adaptation to the workplace. The objective of this study was to identify how nurse managers and senior nurses support new graduate nurses’ information seeking and the expectations underlying such support. Methods: Nurse managers and senior nurses from Japanese hospitals participated in semi-structured interviews. Data were analyzed using qualitative content analysis by coding meaningful units, grouping similar codes into subcategories, and organizing them into broader categories. Ethical approval was obtained from the research ethics committee of the first author’s institution, and written informed consent was obtained from all participants. Results: Participants included twelve nurse managers from five hospitals and fourteen senior nurses from three hospitals. The nurse managers had an average of 7.4 years of supervisory experience, and the senior nurses had an average of 14.2 years of clinical experience. Participants expected new graduate nurses to demonstrate appropriate attitudes toward seeking information, engage in proactive communication to express their needs or uncertainties, take initiative in seeking and obtaining information, and build relationships with senior nurses that would facilitate information seeking. To support these expectations, participants adopted approaches that encouraged information seeking, proactively provided necessary information, and promoted information sharing among peers. Nurse managers also sought to create a work environment in which all staff members collectively nurtured new graduate nurses. Conclusions: To facilitate information seeking among new graduate nurses, nurse managers and senior nurses need to foster a supportive work environment. They also need to recognize the information content, sources, tactics, and timing appropriate for new graduate nurses.

Nursing Reports doi: 10.3390/nursrep16050152

Authors: Leila Sales Maria Ferreira Raquel Pereira Isabel Lucas Rita Marques Inês Bento

Simulation is increasingly recognised as a strategic approach in nursing education for developing clinical competencies within safe learning environments. However, there is limited understanding of how virtual patient simulation supports the early development of clinical reasoning from the perspective of nursing students. Aim: To explore the perceptions of first-year undergraduate nursing students regarding the development of clinical reasoning and collaborative decision-making through virtual patient simulation. Methods: A qualitative, descriptive, and exploratory design was adopted. Semi-structured focus groups were conducted with 73 first-year undergraduate nursing students. Data were analysed using thematic content analysis following Bardin’s approach. Results: Students perceived virtual patient simulation as a meaningful and high-impact learning strategy. Realism, interactivity, and group collaboration emerged as key strengths. Engagement with dynamic clinical scenarios supported the integration of theoretical knowledge into practice, enhanced prioritisation skills, and promoted structured clinical reasoning. Collaborative learning facilitated shared reflection and collective problem-solving, while immediate feedback enabled learning through error within a psychologically safe environment. Participants also reported increased confidence and autonomy in decision-making. At the same time, students identified limitations related to software constraints and the alignment between automated assessment and their reasoning processes. Conclusions: Group-based virtual simulation appears to support the early structuring of clinical reasoning, extending beyond technical skill acquisition to foster reflective and collaborative practice. Its educational value, however, depends on intentional curricular integration and strong pedagogical alignment including structured facilitation, alignment between assessment and learning objectives, and opportunities for guided reflection. These findings contribute to a process-oriented understanding of how novice learners make sense of clinical reasoning in simulated contexts.

Nursing Reports doi: 10.3390/nursrep16050151

Authors: Huina Zou Linjing Wu Kaixin Li Polun Chang Yuan Chen

Background/Objectives: Nursing informatics competency is critical for nursing students entering clinical practice in the digital era. Current undergraduate nursing informatics courses prioritize theoretical instruction but lack sufficient integration with clinical applications, which restricts the depth of content delivery. This study aimed to design, implement, and conduct a preliminary evaluation of an undergraduate nursing informatics literacy course. Methods: This was a single-arm mixed-methods study. We implemented five sequential steps aligned with the Analysis, Design, Development, Implementation, and Evaluation (ADDIE) model: (1) needs assessment, (2) design of a systematic, progressive course spanning theoretical foundation, technical skills, and clinical application; (3) development of teaching materials and environment; (4) implementation through nine weekly 90 min sessions incorporating teach–practice–feedback; and (5) evaluation via a customized questionnaire and nursing informatics system project reports. Quantitative data were analyzed using the mean, standard deviation, and paired t tests; qualitative data were collected through post-course semi-structured interviews. Results: A total of 120 participants were enrolled from a provincial public medical school, of which 119 (99.2%) completed the course. Statistically significant pre–post improvements were observed in participants’ nursing informatics competencies, informatics literacy self-efficacy, and innovative behavior after course completion (p < 0.001). Participants completed 12 group projects, which received two C grades, nine B grades, and one A grade. Overall course satisfaction averaged 89.03 ± 14.62. Qualitative interviews yielded three themes: (a) cognitive reconstruction and improvement in the ability to apply nursing informatics competencies, (b) dilemmas and breakthroughs in the integration of technology and knowledge in nursing informatics design, and (c) optimization direction of course content, design, and evaluation. Conclusions: An ADDIE-based nursing informatics literacy course may be associated with improvements in nursing informatics competencies, informatics literacy self-efficacy, and innovative behavior among nursing undergraduates. This study provides preliminary evidence supporting the feasibility and potential educational value of such a curriculum.

Nursing Reports doi: 10.3390/nursrep16050150

Authors: Itziar Hoyos Cillero Iñigo Lorenzo Ruiz

Background/Objectives: Limited research has examined the correlates among the lifestyle habits of nursing students, whose suboptimal behaviors may compromise their ability to model and promote healthy lifestyles in future professional practice. This study aimed to assess health-promoting lifestyle behaviors, explore interrelationships among lifestyle domains, and identify key correlates of positive health-promoting lifestyle behaviors to inform the development of targeted interventions. Methods: A cross-sectional study was conducted among 476 undergraduate nursing students in Spain. Data included sociodemographic, academic, and health-related variables, along with Health-Promoting Lifestyle Profile II (HPLP-II) scores. Descriptive statistics, correlations, and hierarchical multivariate logistic regression were used to identify factors associated with positive health-promoting lifestyle behaviors. Results: Overall HPLP-II scores indicated modest health-promoting lifestyle behaviors (adjusted mean 2.62 ± 0.33), with the lowest scores observed for health responsibility (adjusted mean 2.20 ± 0.48) and stress management (adjusted mean 2.33 ± 0.44). Health-related variables showed stronger associations with positive health-promoting lifestyle behaviors than sociodemographic or academic variables (p < 0.001). Significant correlates of positive health-promoting lifestyle behaviors included higher adherence to the Mediterranean diet, greater levels of physical activity, and concurrent employment during studies. Conclusions: Support of nutrition, physical activity, and other health-promoting lifestyle behaviors should be strengthened in nursing curricula and training environments. Educational strategies should move beyond theoretical instruction through student-centered approaches, enhancing self-care and the ability to promote health in future professional practice.

Nursing Reports doi: 10.3390/nursrep16050149

Authors: Verónica Pérez-Muñoz Antonio Jesús Ramos-Morcillo Alonso Molina-Rodríguez María Ruzafa-Martínez

Background: Evidence-based practice (EBP) is a cornerstone of high-quality and safe nursing care. However, undergraduate nursing students often experience cognitive, methodological, and contextual barriers to learning and applying EBP. Active teaching strategies, such as the flipped classroom, may support the development of EBP competencies, yet qualitative evidence exploring students’ learning experiences remains limited. Objectives: To explore nursing students’ perceptions and experiences of learning evidence-based practice through a flipped classroom model. Methods: A qualitative descriptive study was conducted at the Faculty of Nursing of the University of Murcia (Spain). Purposeful maximum variation sampling was used to recruit undergraduate nursing students from the second and fourth academic years who had completed an EBP course delivered using a flipped classroom approach supported by an online learning platform. Twenty semi-structured interviews were conducted via videoconference. Data were transcribed verbatim and analyzed using reflexive thematic analysis with independent coding by two researchers and consensus procedures. Ethical approval and confidentiality were ensured. Results: Three main themes were identified: (1) transformation of the meaning of EBP learning and professional role, (2) cognitive and metacognitive processes in EBP learning, and (3) the learning experience as a catalyst for deep learning. Students described a shift from initial fear and perceived difficulty toward recognizing the practical value of EBP, accompanied by increased critical thinking, autonomous learning, and a growing evidence-informed professional identity. The flipped classroom model facilitated engagement and understanding, while the transfer of learning to clinical practice was influenced by contextual facilitators and barriers. Conclusions: Learning EBP through a flipped classroom was experienced as a transformative process that fostered critical thinking, self-regulated learning, and the construction of an evidence-oriented professional identity among nursing students. Strengthening information literacy skills and improving alignment between academic and clinical environments may enhance the sustainable application of EBP in clinical practice.

Nursing Reports doi: 10.3390/nursrep16050148

Authors: Won Ju Hwang Hwiyun Kim Nancy R. Reynolds

Background: Although pre-exposure prophylaxis (PrEP) has demonstrated strong clinical efficacy in preventing HIV infection among men who have sex with men (MSM), real-world utilization remains suboptimal. In South Korea, MSM constitute a major population within the domestic HIV epidemic; however, PrEP uptake has not increased pro-portionally to awareness. This discrepancy has been conceptualized as the “awareness–uptake gap,” reflecting multi-level barriers beyond individual knowledge. Purpose: This integrative review aimed to compare PrEP awareness, acceptance, and utilization among MSM populations in South Korea and international settings, and to identify structural, institutional, and psychosocial determinants contributing to the awaness, uptake gap. The study further sought to derive practical implications for nursing practice and health policy. Methods: An integrative literature review was conducted following Whittemore and Knafl’s five-step methodology and reported in line with PRISMA guidance. Electronic searches were performed in PubMed, Google Scholar, RISS, ScienceON, and DBpia for peer-reviewed studies published between 2015 and 2025 in English or Korean. The final search was completed on 31 January 2026. A total of 5952 records were identified, and 187 studies met the inclusion criteria after screening and duplicate removal. Quality appraisal was conducted using AXIS, Newcastle-Ottawa Scale, RoB 2.0, CASP, and MMAT according to study design, and the findings were synthesized within an environmental–structural–individual framework. Results: The included studies consistently showed that awareness of PrEP exceeded actual uptake. Across settings, the awareness–uptake gap was shaped by policy environment, service accessibility, stigma, privacy concerns, economic burden, institutional complexity, and provider preparedness. Comparative evidence from China, Thailand, Belgium and France, Brazil, and West Africa further suggested that awareness alone did not ensure uptake when service pathways were fragmented, culturally unsafe, or poorly understood. Conclusions: Closing the awareness–uptake gap requires integrated policy and practice strategies that extend beyond cost reduction. Strengthening confidentiality systems, simplifying service pathways, and enhancing provider competency—particularly through nurse-centered PrEP navigation and counseling models—may support more sustainable PrEP expansion among MSM populations in global settings.

Nursing Reports doi: 10.3390/nursrep16040147

Authors: Trinidad Maria Galera-Barbero Vanesa Gutierrez-Puertas Helder Jaime Fernandes Blanca Ortiz-Rodriguez Alba Sola-Martinez Lorena Gutierrez-Puertas

Background/Objective: In Spain, 99% of births occur in hospital settings, and planned home birth is neither funded nor regulated by the Public Health System. Despite growing interest in this birth option, qualitative evidence exploring the experiences of women who opt for a planned home birth after a previous hospital birth remains scarce, particularly in contexts where this practice is not integrated into the healthcare system. This study aimed to explore the perceptions and experiences of Spanish women who opted for a planned home birth following a previous hospital birth, focusing on the reasons that motivated this decision and the care received during the process. Methods: A qualitative descriptive design was employed. Semi-structured interviews were conducted between July and December 2025 with 19 women who had experienced a planned home birth in Spain after a previous hospital birth. Data were analysed using inductive thematic analysis following Braun and Clarke’s approach. The study adhered to the Standards for Reporting Qualitative Research (SRQR). Results: Three main themes emerged: (1) motives related to choosing a planned home birth, including negative hospital experiences characterised by loss of autonomy, medicalisation of birth without consent, and fragmented care; (2) seeking a physiological and humanised birth, reflecting women’s desire for empowerment, control, and a transformative experience, alongside barriers such as lack of professional support and financial burden; and (3) the need to increase visibility and establish regulation, highlighting demands for professional training, dissemination strategies, and integration of planned home birth into the Public Health System to ensure equitable access. Conclusions: Women who opted for a planned home birth after a hospital experience reported highly positive and empowering outcomes. However, the absence of regulation, professional support, and public funding creates significant inequalities. Integrating planned home birth into the Public Health System, educating healthcare professionals, and developing strategies to increase the visibility of planned home births are essential to guarantee women’s right to choose where they give birth.

Nursing Reports doi: 10.3390/nursrep16040146

Authors: Wínola Dafny Douglas de Oliveira Maria Eduarda Leite Pinto Ghirotti Álvaro Francisco Lopes de Sousa Adaiele Lúcia Nogueira Vieira da Silva Herica Emília Félix de Carvalho Marília Duarte Valim Aires Garcia dos Santos Júnior

Background: Safe medication administration is a fundamental aspect of nursing practice and a core component of patient safety. However, systemic failures, workload pressures, and educational gaps continue to contribute to medication errors, posing persistent challenges for healthcare systems. In this context, innovative educational technologies, particularly Artificial Intelligence (AI), have emerged as promising strategies to support the development of competencies related to safe medication administration. Methods: This scoping review aimed to map evidence on AI-based tools used to teach safe medication administration in nursing. The review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology and reported following the PRISMA-ScR guidelines. Searches were performed in PubMed, Scopus, Web of Science, LILACS, and Google Scholar, covering studies published between 2010 and October 2025 in English, Portuguese, and Spanish. Study selection was conducted in two stages, followed by standardized data extraction. Results: A total of 545 records were identified, of which only two studies met the eligibility criteria. The included studies, conducted in Israel and South Korea, evaluated a microlearning chatbot and Large Language Model (LLM)-based tools designed to support teaching safe medication administration. Both studies demonstrated improvements in knowledge and performance in tasks and simulations related to the medication process, as well as positive acceptability among participants. However, neither study assessed direct clinical outcomes, such as reductions in medication errors or preventable adverse events. Conclusions: Although AI-based educational tools show potential to enhance competencies related to medication safety in nursing, the available evidence remains limited. Further robust, multicenter, and comparative studies are needed to evaluate their impact on clinical outcomes and to support their integration into nursing education and practice.

Nursing Reports doi: 10.3390/nursrep16040145

Authors: Ahmed Yahya Ayoub Carin Maree Neltjie van Wyk

Introduction: Work engagement among nurse case managers is central to safe, efficient, person-centred care, yet organisational and team-level factors that support engagement or mitigate burnout remain poorly synthesised. Aim: To map organisational and team-level strategies that enhance work engagement or reduce burnout among nurse case managers and aligned roles, as well as to consider their applicability to Gulf health systems. Method: We conducted a scoping review in accordance with the Arksey and O’Malley framework as refined by Levac et al. and reported it in line with PRISMA-ScR and PRISMA-S guidance. Six databases and targeted sources were searched for English-language records published between 2015 and 2025. Two reviewers independently screened titles/abstracts and full texts against predefined eligibility criteria, charted data using a piloted form, and synthesised findings thematically against Job Demands–Resources (JD-R) domains. Results: Of 303 records identified, 248 were screened after deduplication, and 11 studies were included. Across nine health systems, findings were mapped to three JD-R domains: job resources, job demands, and personal resources. The most recurrent resource-related strategies involved structural supports, staffing stability, coordination infrastructure, and supportive leadership or team practices. Key demands included role complexity, high caseloads, coordination workload, discharge pressures, and staffing instability. Personal-resource approaches were fewer and mainly involved stress management, communication, and reflective practice interventions. Engagement was infrequently measured directly, and only one empirical intervention study originated from a Gulf health system. Conclusions: This JD-R-informed scoping review suggests that strengthening structural, staffing, and coordination resources, alongside supportive leadership and team climates, may be important for sustaining engagement and limiting burnout among nurse case managers. However, these findings should be interpreted as exploratory signals that map the current evidence landscape rather than definitive evidence of effectiveness. Multi-component JD-R-informed bundles in Gulf region health systems should therefore be prioritised for context-sensitive co-design, piloting, and evaluation.

Nursing Reports doi: 10.3390/nursrep16040144

Authors: Elisa Porcelli Carla Murgia Serena Caponetti Gennaro Rocco Alessandro Stievano Ippolito Notarnicola

Background: Spirituality and religious diversity are increasingly recognized as essential components of holistic nursing care in global healthcare systems. However, their integration into undergraduate nursing education remains heterogeneous and often insufficiently structured, creating a gap between professional values and students’ preparedness to address spiritual needs in culturally diverse clinical environments. This study aimed to explore nursing students’ perceptions, attitudes, and perceived competencies regarding spirituality, religion, and spiritual care. Methods: A descriptive exploratory survey was conducted on a sample of 69 third-year nursing students (69.6% female; majority aged ≤24 years) enrolled in two universities in Rome, Italy. Data were collected between May and July 2025 using the Nursing Care and Religious Diversity Scale (NCRDS), consisting of 31 items. Statistical analyses included descriptive statistics, internal reliability analyses, group comparisons, and multivariate regression models. Results: Students showed moderate levels of attention to patients’ spiritual needs (mean = 3.11, SD = 0.88) and integration of spirituality into care practice, while high importance was attributed to spiritual care skills. University education was perceived as only partially adequate. Multivariate analyses showed that students’ personal spirituality is positively associated with the assessment of spiritual needs and the perception of competence, while exposure to contexts characterized by greater religious diversity is associated with a lower perception of preparedness. Conclusions: The results highlight a discrepancy between professional values and perceived operational skills, suggesting the need to systematically integrate spirituality and religious diversity into nursing curricula. These findings highlight the need for a structured integration of spirituality and religious diversity into nursing curricula through targeted educational strategies in order to strengthen students’ competencies and promote truly holistic and person-centered care.

Nursing Reports doi: 10.3390/nursrep16040143

Authors: Anna Tsiakiri Konstantinos Tzanas Despoina Chrisostomidou Spyridon Plakias Foteini Christidi Christos Frantzidis Nikolaos Aggelousis Maria Lavdaniti Evangeli Bista

Background/Objectives: Cancer-related terminology is not merely descriptive and plays a critical role in shaping emotional responses, personal identity, and communication across clinical, social, and public spheres. Despite growing interest in the psychosocial dimensions of illness language, few studies have centered the lived experiences of individuals navigating cancer through the lens of terminology. This study explores how people living with and beyond cancer perceive, interpret, and emotionally respond to cancer-related language, focusing on the way terminology influences identity, stigma, and communicative interaction. Methods: A sequential mixed-methods design was employed. The quantitative phase involved 146 participants with a cancer diagnosis completing a structured questionnaire on preferred terminology and emotional impact. The qualitative phase followed, using open-ended questionnaires with 11 participants to deepen understanding of linguistic experiences. Thematic content analysis was used to identify patterns across narratives. Results: These findings reveal that labels such as “cancer patient” evoke strong negative emotional reactions, associated with stigma, fear, and identity reduction. Person-first and context-sensitive language was perceived as more respectful and empowering. Emotional responses to language varied widely, from fear to neutrality, shaped by speaker role, context, and time since diagnosis. Media representations were often seen as dramatizing or moralizing, reinforcing the need for communicative clarity, empathy, and education in both clinical and public discourse. Conclusions: Cancer-related language is a powerful psychosocial force. It shapes how individuals are seen and see themselves and can either reinforce stigma or foster dignity and resilience. This study highlights the urgent need for person-centered, context-aware communication practices across healthcare, media, and society.

Nursing Reports doi: 10.3390/nursrep16040142

Authors: Misa Iida Sumiyo Nabeshima Sayuri Kaneko Yuji Kamijo Toshio Kobayashi Yukako Ando

Objective: This study aimed to compare factors facilitating shared decision-making (SDM) in renal replacement therapy decision support between physicians and nurses using text mining analysis. Methods: A web-based survey was conducted among 250 physicians and 299 nurses between December 2024 and March 2025. Free-text responses regarding factors facilitating SDM were collected and analyzed using quantitative text analysis. Results: Valid responses were obtained from 103 physicians and 122 nurses. Both groups identified six factors, with three shared conceptual domains across physicians and nurses, reflected in three physician factors and four nurse factors. Common domains included “promoting patient and family understanding”, “enhancing staff education”, and “strengthening multidisciplinary collaboration”. Physicians emphasized structural and environmental factors, such as “establishing clinical systems”, “inter-institutional collaboration”, and “securing sufficient time”. In contrast, nurses highlighted practical and interpersonal aspects, including “understanding patients’ values and lifestyles”, “supporting patient-centered decision-making”, and “promoting team-based information sharing”. Conclusions: Factors that facilitate SDM in renal replacement therapy include perspectives common to both physicians and nurses, as well as profession-specific perspectives. These findings suggest that integrating organizational support and clinical skills development is crucial for promoting SDM in clinical settings.

Nursing Reports doi: 10.3390/nursrep16040141

Authors: Cátia Moreira Pedro Moutinho Paulo Alves Liliana Mota

Background/Objective: Leadership in nursing has been conceptualized as a multidimensional construct influencing organisational functioning and professional practice. Within the Full Range Leadership Model, leadership comprises transformational, transactional, and passive–avoidant dimensions that may coexist within individuals. This study aimed to examine how leadership dimensions coexist and interact among nurses and to explore their associations with professional characteristics within the FRLM framework. Methods: A cross-sectional quantitative study was conducted between November and December 2024 among 141 Portuguese nurses affiliated with a professional association dedicated to nursing leadership. Leadership behaviours were assessed using the Multifactor Leadership Questionnaire. A non-probability convenience sampling strategy was used. Descriptive and inferential analyses were performed using SPSS. Results: Transformational leadership emerged as the predominant behavioural pattern (M = 3.17, SD = 0.38), followed by transactional leadership (M = 2.51, SD = 0.46), with minimal laissez-faire behaviours (M = 0.83, SD = 0.50). Managers demonstrated significantly higher transformational scores (mean difference = 0.16, p = 0.018) and lower laissez-faire scores (mean difference = −0.27, p = 0.01) than specialists. Transformational leadership was positively correlated with transactional leadership (r = 0.309, p < 0.01) and negatively correlated with laissez-faire behaviours (r = −0.339, p < 0.01). Conclusions: The findings indicate a predominant transformational leadership profile among nurses, accompanied by complementary transactional behaviours and low passive–avoidant tendencies. The observed correlations support a dimensional interpretation of leadership consistent with the Full Range Leadership Model. These findings provide descriptive insight into leadership patterns within this nursing sample and may inform leadership development initiatives in comparable healthcare contexts.

Nursing Reports doi: 10.3390/nursrep16040140

Authors: João Miguel Almeida Ventura-Silva Olga Maria Pimenta Lopes Ribeiro Elaine Cristina Novatzki Forte Letícia de Lima Trindade Susana Filipa Mendes Castro Marlene Patrícia Ribeiro Diana Moreira Sanches Sónia Cristina Costa Barros Irina Alexandra Lopes Almeida David Rigor Lage Samuel Spiegelberg Züge

Objectives: This study aimed to evaluate the relationship between quiet quitting and burnout among nurses, considering the influence of sociodemographic and occupational factors in healthcare settings. Methods: This cross-sectional, observational, and quantitative study was conducted from April to July 2025 in health services in northern Portugal, involving 1097 nurses who completed a questionnaire, the Silent Employment Abandonment Scale, and the Shirom–Melamed Burnout Scale. Descriptive and inferential analyses examined associations between sociodemographic variables, work context, and outcomes. Results: The 1097 participating nurses showed a positive correlation between overall quiet quitting and total burnout across all domains. Burnout remained significantly associated with overall quiet quitting after adjustment, and physical and cognitive fatigue showed the most consistent independent associations across models. The strongest coefficients were observed for the ‘lack of motivation’ dimension. Conclusions: Quiet quitting was consistently associated with burnout among nurses after adjustment for sociodemographic and occupational factors. The pattern of results was stronger for physical and cognitive fatigue and for lack of motivation, supporting the interpretation of quiet quitting as an important correlation of occupational strain in nursing and reinforcing the need for organizational and leadership strategies that reduce fatigue and sustain professional engagement.

Nursing Reports doi: 10.3390/nursrep16040138

Authors: Sofía Martínez-León Alba Francisco-Sánchez Beatriz Rescalvo-Arjona Pedro Ruymán Brito-Brito Martín Rodríguez-Álvaro

Cardiopulmonary arrests are time-dependent emergencies where survival rates are quickly reduced without early intervention. BLS training programmes for teachers and schoolchildren must be mandatory, as they not only improve efficacy when performing the manoeuvres but also enhance willingness to do so. Background/Objectives: To analyse changes in knowledge and whether they are sustained in time after a theoretical–practical intervention led by nurses. To objectively analyse the quality of chest compressions according to the students’ group and age. Methods: A quasi-experimental study without a Control Group and with three measuring instances: Baseline (T0), Immediate post-intervention (T1) and at three months (T2). Knowledge was assessed by means of an ad hoc questionnaire; in turn, the chest compressions were evaluated using a mannequin with feedback. The longitudinal changes were analysed based on paired discordant answers. Descriptive analyses according to age and schooling level were performed. Results: There were 982, 756 and 509 students at T0, T1 and T2, respectively. A total of 206 records were paired at all three measuring moments. The intervention was associated with an increase in knowledge test scores, which is preserved at three months. Most of the questionnaire items presented positive changes or remained unchanged. The significant difference was maintained in 8 of the 10 questions. As for the compressions, a significant and positive correlation was found between age and overall score, depth and rate. The comparative analysis between the Lower Secondary Education and Higher Secondary Education groups found significant differences in those same variables, as well as a difference in release. Conclusions: Altogether, the results of this study contribute evidence about the effectiveness of BLS training among adolescents in a real-world context, underscoring the need for ongoing and age-adapted interventions.

Nursing Reports doi: 10.3390/nursrep16040139

Authors: Chrysi A. Fragkioudaki Enkeleint A. Mechili Petros Galanis Evridiki Patelarou Konstantinos Giakoumidakis Athina E. Patelarou

Background: Rapid technological progress has transformed healthcare systems through integrating electronic health (eHealth) into clinical practice. Consequently, nursing students, upcoming healthcare professionals, face new challenges arising from this digital transition. Adequate technological skills and eHealth literacy are essential to meet the requirements of contemporary healthcare environments. The aim of this study was to translate, culturally adapt, and validate a questionnaire measuring technophilia, Internet use, eHealth literacy, and nursing students’ attitudes toward technology and eHealth. Methods: A cross-sectional validation study was conducted using a convenience sample of Albanian undergraduate nursing students. After forward and backward translation, the instrument’s construct validity was examined using exploratory factor analysis (EFA). Cronbach’s alpha assessed internal consistency, and the relationships among the four constructs were explored using structural equation modeling (SEM). Results: A total of 357 undergraduate nursing students participated in the survey. EFA identified a clear four-factor structure corresponding to Technophilia, Internet Use, eHealth Literacy, and Technology and Electronic Health in Nursing Education, with all items demonstrating satisfactory factor loadings. Internal consistency of the four scales ranged from 0.692 to 0.852, indicating generally satisfactory reliability. Although the SEM model fit was below the recommended thresholds, the results provide some evidence for relationships among the constructs. Conclusions: The findings provide preliminary evidence for the reliability and validity of the adapted instrument and set a baseline for assessing Albanian nursing students’ knowledge, skills, and attitudes regarding technology and eHealth literacy. Several strategies can be developed based on this evidence to prepare nursing students for technologically advanced healthcare systems.

Nursing Reports doi: 10.3390/nursrep16040137

Authors: Marta Fernández Idiago Juan Francisco Velarde-García Oscar Arrogante Ignacio Zaragoza-García Beatriz Álvarez-Embarba Victor Fernández-Alonso Leticia López-Pedraza

Background: Emergency obstetric situations require rapid clinical decision-making, technical competence, and emotional preparedness to ensure safe and compassionate care for both mother and newborn. However, nursing students often have limited opportunities to experience such high-risk, low-frequency events during clinical placements. Simulation-based education has emerged as an effective strategy to prepare future nurses for caring in emergency contexts, allowing them to develop both technical and non-technical skills in a safe learning environment. This study aimed to evaluate the effects of a high-fidelity obstetric emergency simulation program on nursing students’ knowledge, perceived safety, and learning experience. Methods: A mixed-methods design was employed, combining a quasi-experimental pretest–posttest assessment without a control group and qualitative analysis of open-ended reflections. Eighty-two third-year nursing students participated in two simulation sessions addressing obstetric emergencies such as breech birth, shoulder dystocia, out-of-hospital delivery, eclampsia, postpartum hemorrhage, and maternal cardiac arrest. Data were collected using validated instruments measuring knowledge, perceived safety, and satisfaction and self-confidence in learning, and were analyzed using Wilcoxon signed-rank tests and thematic analysis. Results: Significant improvements were observed in specific knowledge areas related to complex obstetric maneuvers and in their perceived safety when managing emergency situations (p < 0.001, r > 0.40). Participants reported high levels of satisfaction and confidence in learning. Qualitative findings highlighted increased emotional preparedness, improved clinical reasoning, and recognition of the importance of teamwork and reflective debriefing in emergency care contexts. Conclusions: High-fidelity simulation appears to be an effective educational strategy for preparing nursing students to provide safe and confident care in obstetric emergencies. Integrating simulation into nursing curricula can strengthen both technical competence and the emotional readiness required for caring in urgent and high-pressure clinical situations.

Nursing Reports doi: 10.3390/nursrep16040136

Authors: Clint Moloney Gavin Beccaria Amy B. Mullens

Background: Chronic Obstructive Pulmonary Disease (COPD) remains a leading cause of emergency department (ED) presentation, hospitalisation, and preventable healthcare utilisation worldwide. Although guidelines advocate coordinated, preventative, and community-based management, care within ED settings often remains reactive and crisis-driven. Nurses occupy a central role in COPD management; however, the experiential dimensions of nursing practice and its contribution to improving patient outcomes are insufficiently understood. Objectives: To explore the lived experiences of patients, nurses and medical officers regarding COPD presentations to the ED, with particular focus on the nursing role in assessment, coordination, education, and identification of unmet and comorbid care needs. Methods: A qualitative phenomenological approach was undertaken across three regional Australian EDs. Purposive sampling recruited patients presenting with acute exacerbations of COPD and nursing and medical officers involved in their care. Semi-structured interviews were conducted and transcribed verbatim. Data were analysed using Braun and Clarke’s thematic analysis framework, supported by reflexive discussion and audit trails to enhance rigour. Results: Six interrelated themes were identified: (1) nursing within a “crisis first” model of care; (2) holistic assessment and translation of complexity; (3) education and care coordination as preventative nursing work; (4) relational care and therapeutic connection; (5) nurses as sentinels for undiagnosed comorbidities, particularly obstructive sleep apnoea; and (6) system pressures constraining optimal nursing practice. Participants consistently described nurses as the clinicians who stabilised acute episodes, interpreted contextual risks, coordinated services, and provided relational and educational support, yet whose preventative contributions were limited by time and organisational demands. Conclusions: ED nurses function as critical integrators between acute stabilisation and chronic disease management for patients with COPD. Formalising nurse-led assessment, education, coordination, and sleep-disordered breathing screening may reduce avoidable ED presentations and enhance patient-centred outcomes. Investment in structured nursing models represents a key opportunity for improving COPD care delivery.

Nursing Reports doi: 10.3390/nursrep16040135

Authors: Grace Crolly-Burton Gary Mitchell Clare McKeaveney Stephanie Craig

Background: Chronic kidney disease (CKD) is highly prevalent among older adults, particularly those living in care homes, where early identification and effective management are essential to improving outcomes. Aim: This scoping review aimed to explore and map educational interventions designed to support care home staff in the prevention, assessment, and management of CKD. Methods: A scoping review (ScR) was conducted and guided by the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for ScR (PRISMA-ScR) checklist. A systematic search of six major databases was conducted following the Joanna Briggs Institute methodology. Results: A total of 6599 records were identified and 5573 titles and abstracts were screened; 10 full texts were assessed, but no studies met the inclusion criteria. Conclusions: This empty review highlights a significant gap in the literature and reinforces the need for targeted research to develop and evaluate training interventions for care home staff managing residents with CKD.

Nursing Reports doi: 10.3390/nursrep16040134

Authors: Salomé Moreno-Vega José C. Vilches Francisco García-Pedrajas Isabel María Morales-Gil Cristóbal Rengel-Díaz

Background/Objectives: Breastfeeding initiation after cesarean section is frequently delayed due to postoperative routines and early mother–infant separation. Enhanced Recovery After Surgery (ERAS) protocols have been introduced in obstetrics to improve maternal recovery and may facilitate practices aligned with a family-centered model of care. The aim of this study was to evaluate the association between ERAS implementation and breastfeeding outcomes, including early feeding patterns and effective breastfeeding at discharge. Methods: An analytical longitudinal study was conducted including women undergoing scheduled cesarean section between January 2025 and November 2025 at Quirón Salud Málaga Hospital (Spain). A total of 131 women were enrolled in this study. Two groups were compared: an exposed group that received an ERAS protocol (n = 65) for scheduled cesarean section and a control group (n = 66) managed with conventional in-hospital care. An intrasubject analysis was conducted, and associations were assessed using odds ratios (ORs) with 95% confidence intervals (CIs). Multivariable logistic regression was performed to identify factors independently associated with effective breastfeeding. Results: The ERAS group showed a stable feeding pattern over time, with a high persistence of exclusive breastfeeding (Stuart–Maxwell χ2(2) = 1.14; p = 0.565). In multivariable analysis, ERAS implementation remained an independent factor (adjusted OR 3.79; 95% CI 1.50–9.55; p = 0.005), together with early skin-to-skin (adjusted OR 2.68; 95% CI 1.13–6.36; p = 0.026), as was breastfeeding support (adjusted OR 2.72; 95% CI 1.02–7.22; p = 0.045). LATCH scores were also higher in the ERAS group (p = 0.0005; r = 0.34). Conclusions: Women managed under ERAS presented a higher prevalence of exclusive breastfeeding at hospital discharge and better breastfeeding performance. ERAS implementation was associated with improved breastfeeding outcomes, possibly through clinical conditions that facilitate early contact and structured breastfeeding support.

Nursing Reports doi: 10.3390/nursrep16040133

Authors: Paschalina Lialiou Aglaia Katsiroumpa Parisis Gallos Olympia Konstantakopoulou Ioannis Moisoglou Olga Galani Maria Tsiachri Petros Galanis

Background/Objectives: Artificial intelligence (AI) has transformed healthcare delivery by revolutionizing the offering opportunities in prognosis, diagnosis, personalized treatment, and improving patient outcomes. However, little is known about the nurses’ attitudes toward the integration of AI-driven conversational technology and AI chatbots into clinical practice. The aim of our study was to investigate nurses’ attitudes regarding the use of AI chatbots as a tool for mental health support. Additionally, the study aimed to evaluate their levels of acceptance and fear toward AI, while examining the influence of demographic variables on these attitudes. Methods: A cross-sectional study was conducted. We employed the Artificial Intelligence in Mental Health Scale (AIMHS) to measure attitudes toward the use of AI-powered chatbots for mental health support. Additionally, we utilized the Attitudes Towards Artificial Intelligence Scale (ATAI) to assess nurses’ levels of acceptance and fear regarding artificial intelligence. Results: Technical advantages score in the AIMHS reflected low positive attitudes toward the technical aspect of AI chatbots for mental health support, while personal advantages score showed moderate positive attitudes toward the personal aspect of chatbots. ATAI scores indicated a moderate level of acceptance and fear toward AI. Results from multivariable analysis showed that increased age (b = 0.011, p-value = 0.018) and increased daily engagement with social media and websites (b = 0.058, p-value = 0.002) were significantly associated with more favorable technical attitudes towards AI-based mental health chatbots. Also, male nurses exhibited significantly more favorable attitudes toward AI-based mental health chatbots in terms of perceived personal benefits (b = 0.548, p-value < 0.001). Higher levels of digital technology competence were significantly associated with greater acceptance of artificial intelligence (b = 0.164, p = 0.032). Additionally, male nurses reported significantly higher acceptance of AI compared to their female counterparts (b = 1.587, p < 0.001). We found that lower financial status was significantly associated with heightened fear of AI (b = −0.329, p < 0.001). Conclusions: Nurses generally held moderately positive attitudes toward both AI-based mental health chatbots and AI more broadly. Several demographic factors were found to significantly influence these attitudes.

Nursing Reports doi: 10.3390/nursrep16040132

Authors: Yangama Jokwiro Qiumian Wang Jennifer Bassett Sandra Connor Edward Zimbudzi

Background: Nursing student experiences in the clinical learning environment have been described in many countries but less is known about student nurses in rural settings. Aim: To explore undergraduate nursing students’ experience of clinical placement in a rural setting and identify factors that influence their experience. Methods: A cross-sectional observational study was conducted with a convenience sample of 170 undergraduate nursing students in regional Victoria, Australia, who completed professional experience placements between January and June 2020. Following their placements, participants completed the Clinical Learning Environment, Supervision and Nurse Teacher (CLES+T) scale. Data were analysed using logistic regression models. Results: Completing clinical placements in medium to small rural towns or remote and very remote communities were associated with increased odds of high scores in the learning environment [odds ratio (OR) 2.90, 95% CI, 1.32 to 6.37; P = 0.01] and the supervisory relationship domains (OR 3.16, 95% CI, 1.40 to 7.14; P = 0.01). Female gender (OR 3.38, 95% CI, 1.12 to 10.19; P = 0.03), supervision by staff other than an educator (OR 2.71, 95% CI, 1.16 to 6.33; P = 0.02) and increased frequency of ad hoc (extra) supervision with a buddy nurse without the nurse educator (OR 2.55, 95% CI, 1.07 to 4.75; P = 0.03) were associated with increased odds of high scores in the role of nurse educator domain. Conclusions: In this study, nursing students reported valuing their exposure to smaller and more remote communities, the learning environments within rural and remote healthcare facilities, and the relationships they developed with supervising nurses. The findings also suggest that some students perceived greater value in supervision provided by clinical staff who were not in formal nurse educator or nurse facilitator roles. Given the limitations of the study, these observations should be interpreted cautiously and may warrant further investigation in broader contexts.

Nursing Reports doi: 10.3390/nursrep16040131

Authors: Helen Donovan

Background: Early-career registered nurses and midwives often encounter intense stressors that affect their physical, mental, emotional, and social well-being. While some challenges serve as valuable learning opportunities, others are traumatic and burdensome. These negative experiences can profoundly influence ongoing professional development and, for some, act as a catalyst for burnout and premature departure from the profession. Methods: This qualitative phenomenological study involved 51 registered nurses and midwives within their first three years of practice at an Australian hospital. The research aimed to identify the challenges faced by participants during their initial years and to explore how these experiences shaped their perceptions of ongoing practice. Results: Many participants in their second and third years of practice, who had difficult first-year experiences, described in detail the impact of their initial encounters on their formative nursing practice during the interviews. The challenges faced in the second and third years were often considered insignificant in comparison to the traumatic events of the first year. Some participants reported requiring long-term psychological support as a result of first year experiences and expressed uncertainty about continuing in the nursing profession. Conclusions: Ensuring that first-year experiences are positive, supportive, and rewarding is crucial for new nurses and midwives. When this period is marked by trauma, emotional distress can escalate, leading to burnout and an increased likelihood of professional attrition. Supporting graduates’ well-being and addressing their individual needs during these formative years is essential for workforce sustainability.

Nursing Reports doi: 10.3390/nursrep16040130

Authors: Erwin Dedi Afandi Usman M. Tang Aria Gusti

Background: Hospital-acquired infections (HAIs) pose significant safety risks, making nursing students’ behavioural intention during clinical rotations vital for prevention. Objective: To analyze the influence of Perceived Behavioural Control (PBC) and knowledge on students’ intention to maintain a safe clinical environment. Methods: A cross-sectional design was conducted with 242 nursing students at a Type A referral hospital in Pekanbaru, Indonesia. Participants were selected via simple random sampling. Data were collected using validated questionnaires measuring PBC (six indicators), knowledge (three subscales), and behavioural intention. Statistical analysis involved Chi-square tests for unadjusted Odds Ratios (OR) and binary logistic regression to calculate adjusted Odds Ratios (AOR) by entering all variables into the model simultaneously. Results: The majority of participants demonstrated high intention (66.5%) and high PBC (83.9%). In the univariate analysis, all six PBC indicators and general nosocomial knowledge were significantly associated with high intention (p < 0.05), with staff direction (OR = 5.96) and specific training (OR = 4.94) showing the strongest independent effects. However, when all environmental and cognitive variables were entered into the regression model simultaneously, only knowledge of personal protective equipment (PPE) use remained a significant independent factor (AOR = 2.66; 95% CI: 1.40–5.06, p = 0.003). The unadjusted OR emphasized the isolated influence of each factor, whereas the adjusted OR showed that technical knowledge was the only variable to retain significance after controlling for other factors. Conclusions: Technical knowledge regarding PPE use is the primary independent driver of nursing students’ intention to maintain a safe clinical environment. While environmental support and general knowledge are important foundational elements, clinical education should prioritize practical, technical training in protective measures to translate knowledge into behavioural intention effectively.

Nursing Reports doi: 10.3390/nursrep16040129

Authors: Nikolaos Kontodimopoulos Ioanna Anagnostaki Kejsi Ramollari Alexandra Anna Gasparinatou Michael A. Talias

Background: Artificial intelligence (AI) is increasingly integrated into healthcare systems, with important implications for nursing practice and clinical workflows. However, evidence regarding nurses’ digital skills, perceptions, and readiness to adopt AI-enabled technologies remains limited, particularly in national healthcare contexts such as Greece. Objectives: This study examined nurses’ digital skills, perceptions of AI, and readiness for AI adoption in clinical practice, and explored demographic and professional factors associated with these outcomes. Methods: A cross-sectional survey was conducted among 166 nurses working in two public hospitals in Greece. Results: Nurses reported moderate digital skills, with 59.1% indicating competence in email/video communication and 27.2% reporting adequate use of digital security tools, while exposure to AI remained limited (18.0% reported using AI products/services in daily life). Perceived professional impact of AI was moderate, whereas readiness for AI adoption was comparatively lower, with only 7.8% considering health professionals adequately prepared and 7.2% reporting adequate AI training. Statistical analyses indicated that educational level and computer literacy certification were positively associated with digital skills, whereas longer professional experience was negatively associated with readiness for AI adoption. Conclusions: These findings highlight a gap between general digital competence and preparedness for AI-driven healthcare applications and underline the need for targeted education and implementation strategies to support effective and ethical integration of AI in nursing practice. From a nursing workforce perspective, the results underscore the importance of integrating AI literacy into continuing professional education and aligning digital health implementation strategies with clinical nursing practice.

Nursing Reports doi: 10.3390/nursrep16040128

Authors: Francesco Sacchini Francesco Scerbo Karolina Kowalcze Paola Pantanetti Sophia Russotto Otilia Enache Stefano Mancin Cuc Thi Thu Nguyen Diego Lopane Francesca Marfella Gabriele Caggianelli Robert Krysiak Fabio Petrelli Giovanni Cangelosi

Background/Objectives: Chronic diseases pose a major challenge for healthcare systems, requiring integrated, patient-centered approaches that combine clinical management, prevention, and self-care. Lifestyle Medicine (LM) and lifestyle in general offers complementary frameworks to address these needs. However, the potential integration of LM within community nursing—particularly through the role of Family and Community Nurse (FCN)—has not been comprehensively synthesized. This narrative review aimed to synthesize international evidence on the role of community nursing—particularly FCN—in integrating chronic care management and LM view. Methods: For quality assessment, a narrative review was conducted in accordance with the SANRA criteria to enable the integration of heterogeneous evidence and a comprehensive synthesis of this complex topic. Literature searches were performed in the PubMed–Medline database, and the final screening of references from included studies was used to identify relevant manuscripts. Primary studies published in English over the past ten years were screened and analyzed using the PICOS framework. Sixteen eligible studies were included in the final synthesis. Results: The included studies indicated that nurse-led community interventions in LM view were associated with improvements in self-management, treatment adherence, and selected clinical outcomes, such as blood pressure, glycated hemoglobin, and physical activity levels. Empowerment-based approaches and the use of digital or telehealth tools supported patient engagement and health literacy. At the organizational level, multidisciplinary collaboration, shared protocols, and professional leadership emerged as key factors in sustaining continuity and quality of care, while organizational fragmentation and limited training in behavioral counseling were commonly reported barriers. Conclusions: Community nursing, particularly through FCNs, plays a relevant role in integrating chronic care management and LM approaches, contributing to improved self-management, treatment adherence, and selected clinical outcomes. The evidence highlights the importance of empowerment-based interventions, digital support tools, and multidisciplinary collaboration in enhancing care continuity and patient engagement. Addressing organizational barriers and strengthening behavioral counseling training remain essential to support effective implementation in community settings.

Nursing Reports doi: 10.3390/nursrep16040127

Authors: Piyanut Xuto Piyaporn Prasitwattanaseree Tareewan Chaiboonruang Lawitra Khiaokham Nittha Panjaruang Pattarada Chalermliamthong Piyawan Sritawan

Background: Nursing education faces challenges in developing critical thinking and digital literacy among Generation Z students, particularly in maternal–newborn care contexts where evidence-based practice is essential. Objectives: To evaluate the effectiveness of an AI-assisted podcasting intervention on critical thinking and digital literacy among nursing students and explore their experiences. Methods: A convergent mixed-methods design included 48 third-year nursing students who created educational podcasts using AI tools (Sci Space for literature search, Notebook LM for synthesis). Quantitative data were analyzed using paired t-tests; qualitative data from three focus groups (n = 15) underwent thematic analysis. Results: Critical thinking scores increased significantly from 89.71 (SD = 13.43) to 117.29 (SD = 9.94), (t = −13.332, p < 0.001). Digital literacy scores improved from 37.98 (SD = 5.84) to 46.94 (SD = 4.11), (t = −9.407, p < 0.001). Four themes emerged: transformation from anxiety to empowerment, AI as scaffold, distinct tool utility, and future clinical application. Conclusions: These findings suggest that AI-assisted podcasting has the potential to significantly enhance critical thinking and digital literacy among nursing students; however, results should be interpreted with caution given the pre–post design, single-institution sample, and use of researcher-developed instruments.

Nursing Reports doi: 10.3390/nursrep16040126

Authors: Lorena Liñán-Díaz María Desamparados Bernat-Adell Núria Vives-Díaz Vicente Bernalte-Martí

Background/Objectives: This study aimed to assess public stigma toward people with mental health problems and to examine the association between stigma and socioeconomic characteristics, personal mental health history, and contact with individuals with mental health problems. Methods: This observational, descriptive, and cross-sectional study was conducted among the general population in Spain using a sample of 404 participants, the majority of whom were women (71%), with a median age of 38 years (IQR = 26–49); most participants (86.4%) lived in urban areas. The participants completed a self-administered online questionnaire that explored socioeconomic variables and the Community Attitudes towards Mental Illness Scale (CAMI-S, Spanish version). Non-parametric tests (Mann–Whitney U, Kruskal–Wallis, and Spearman correlation), multiple linear regression, and statistical power analyses were performed. Results: The mean CAMI-S total score was 84.89 (SD = 11.122) out of 100, indicating relatively favourable attitudes toward people with mental health problems. Statistically significant associations (p-value ≤ 0.05) were found between CAMI-S scores and variables such as gender, age, place of residence, educational level, mental health disorder, and close contact with someone with mental health disorders. The regression model revealed four significant predictors of lower stigma: identifying as female (β = 2.523; p = 0.037), having a medium or higher educational level (β = 5.061; p = 0.002), experiencing a mental health diagnosis (β = 4.535; p = 0.014), and close contact (β = 4.183; p < 0.001). Conclusions: Social stigma toward people with mental health problems in Spain appears to be generally low, reflecting positive attitudes toward community integration. Being female, having higher education, and personal or close contact with mental health problems are associated with lower stigma.

Nursing Reports doi: 10.3390/nursrep16040125

Authors: Farzana Ashraf Urooj Sadiq Shahnila Tariq Bushra Awan Selma Yıldırım Carlos Laranjeira Murat Yıldırım

Background: Art therapy is an experiential, non-threatening intervention, used especially with children. The current study aimed to explore the effect of integrative art therapy on the psychological well-being (mental health and self-perception) of pediatric cancer patients. Methods: Using a single-group pre–post research design, each therapy session was individually administered to participants for approximately 45 min. Fourteen participants (Boys = 9, Girls = 5) were recruited from the inpatient oncology unit at Shaukat Khanum Memorial Cancer Hospital & Research Centre over two months. The age range was from 5 years to 13 years (M = 7.95; SD = 1.65). Mental health, including physical and emotional symptoms associated with cancer, was assessed using the Edmonton Symptom Assessment Scale-Revised, while self-perception was measured with the House Tree Person projective drawing test. Results: The integrative art therapy model significantly improved positive self-image (F = 16.77, p < 0.01) and reduced negative self-image (F = 99.11, p < 0.01) and mental health problems from the baseline to the second and third phases (F = 19.50, p < 0.01). Conclusions: This integrative approach demonstrates its potential as an effective method to enhance self-perception, alleviate mental health challenges, and improve overall quality of life.

Nursing Reports doi: 10.3390/nursrep16040124

Authors: Agnė Jakavonytė-Akstinienė Karolina Adomavičiūtė

Background: Dementia is one of the most common diseases of the elderly worldwide. Sharing experiences of caring for patients with dementia with other carers is essential to improve the quality of care, promote better outcomes, and learn from others. Aim: to explore nurses’ experiences of working with patients with dementia in Lithuanian supportive treatment and nursing hospitals. Methods: A qualitative descriptive design was employed in this study, with data collected through semi-structured interviews. Nurses with direct experience caring for patients with dementia in supportive treatment and nursing hospitals were recruited through purposive sampling. This sampling strategy was chosen to ensure that participants could provide rich, contextual, and experience-based insights into the phenomenon under investigation. Open-ended questions were divided into three themes: 1. Identifying nursing needs. 2. Care for people with dementia. 3. Patient behavior management and situation management. To ensure methodological rigor and transparency, the Consolidated Criteria for Reporting Qualitative Research (COREQ) were applied throughout the study’s planning, data collection, and analysis processes. Results: Nine nurses working in three different Lithuanian hospitals participated in the study. Theme 1: respondents reported that the needs of patients with dementia depend on their previous lifestyle and hobbies, as well as on essential physiological needs such as eating and drinking, bathing and personal hygiene, and the absence of pain. Theme 2: All participants emphasized that ensuring a safe environment is crucial for people with dementia. Theme 3: When faced with inappropriate patient behaviour, nurses attempt to calm the patient, speak gently, provide distraction, or, when necessary, temporarily separate the patient from others. Additional actions include administering medication and stabilizing the patient. Overall, these findings illustrate that dementia care requires continuous emotional presence, situational judgment, and adaptation to each patient’s individual needs. Conclusions: Patients with dementia require highly individualized care focused on nutrition, hygiene, pain control, and communication. Nurses’ daily activities centered on essential bodily care, medication management, and mobility support to maintain safety and prevent complications.

Nursing Reports doi: 10.3390/nursrep16040123

Authors: José Juan Gómez-Ramos Maria Eloísa Pérez-Ruíz Ingrid Patricia Dávalos-Rodríguez Bernardo Alejandro Mata-Villafan Jaime Jesús Antón-García Noé Moisés Flores-Jiménez Alejandro Marín-Medina

Background: Examining the relationship between burnout and absenteeism is important for understanding how chronic occupational stress translates into economic costs, reduced productivity, and deterioration in the health of nursing staff. The aim of this study was to evaluate absenteeism among nursing staff and its association with burnout from a gender perspective. Methods: A total of 154 nursing professionals with permanent contracts were included. An interview was conducted, which included the collection of sociodemographic data, characteristics related to their employment status, and the Maslach Burnout Inventory questionnaire in its Spanish-validated healthcare personnel version. The absenteeism rate was calculated using information from the hospital’s human resources department. The Mantel–Haenszel test was used to identify the association between burnout and absenteeism from a gender perspective. A p-value < 0.05 was considered statistically significant. Results: The prevalence of burnout was 70.1%; 52.6% reported absenteeism in 2024. The general nursing category was significantly associated with burnout (p = 0.039). Although no association was found between burnout and overall absenteeism, holding multiple jobs was identified as a determinant of partial absenteeism (p < 0.05). The hospital absenteeism rate was 4.8%. No statistically significant difference was found between burnout, gender, and absenteeism, with an adjusted odds ratio of 1.386 (95% CI: 0.75–2.65) after controlling for the effect of gender (χ2MH = 0.672, df = 1, p = 0.412). Conclusions: Nursing staff present a critical level of burnout. No statistically significant difference was found between burnout, gender, and absenteeism, which could indicate that gender roles in the workforce may be changing in our population.

Nursing Reports doi: 10.3390/nursrep16040122

Authors: Richard J. Gray Niall Higgins Piyanee Yobas Alessandro Stievano Daniel Bressington

Following the COVID-19 pandemic, there has been substantial growth in the amount of nursing research conducted online, with participants often recruited via social media platforms [...]

Nursing Reports doi: 10.3390/nursrep16040121

Authors: Marelle Grünthal-Drell Inge Timoštšuk Martin Argus

Background: Professional identity (PI) formation is a central developmental process associated with students’ well-being and ability to cope with professional demands. Healthy lifestyle (HL) and self-care are recognised as resources for sustaining long-term professional engagement. Although both PI formation and HL are considered important in nursing education, their interrelationship remains insufficiently understood. Objective: This review aimed to map and synthesise the existing literature on nursing students’ PI formation and its relationship with HL. Methods: A scoping review was conducted following the Arksey and O’Malley framework, Joanna Briggs Institute guidance, and PRISMA-ScR reporting standards. A systematic search was performed in Web of Science, Scopus, MEDLINE, and PubMed for peer-reviewed studies published 2015–2025. Results: Twelve sources met the inclusion criteria. The relationship between PI and HL is complex, indirect, and not yet clearly conceptualised. Rather than being defined through direct behavioural pathways, it appears to be mediated through mental well-being and related psychosocial aspects, as well as contextual influences. Tensions were identified between expectations of nurses as health role models and students’ lived behaviours. A well-developed PI may function as a protective resource against maladaptive coping and support-adaptive responses to academic and clinical stress. Conclusions: Both PI and HL are predominantly conceptualised as dynamic and contextually embedded processes. More integrative approaches addressing both behavioural and psychosocial dimensions are needed. Future research should adopt conceptually coherent and methodologically balanced designs across diverse educational contexts.

Nursing Reports doi: 10.3390/nursrep16040120

Authors: Denise Rodriguez Medrano Viola Cisari Emanuela Morenghi Daniela Cattani Simone Cosmai Giovanni Cangelosi Sara Morales Palomares Mauro Parozzi Stefano Mancin Fabio Petrelli Diego Lopane Beatrice Mazzoleni

Background/Aims: Resilience is a protective factor that helps nursing students manage the challenges of clinical education. However, the relationships between resilience, clinical internship satisfaction, and psychological well-being remain underexplored. To examine the associations between resilience, satisfaction with clinical internships, and psychological well-being among undergraduate nursing students across academic years and campuses. Methods: A cross-sectional observational study was conducted. A total of 302 undergraduate nursing students from four campuses of a northern Italian university completed three validated instruments: the 14-item Resilience Scale (RS-14), the Clinical Learning Quality Evaluation Index (CLEQI), and the 12-item General Health Questionnaire (GHQ-12). Descriptive, correlational, and multiple regression analyses were performed. Results: Resilience was positively associated with clinical learning satisfaction and inversely associated with psychological distress. Regression models confirmed resilience as a significant predictor of both clinical satisfaction (p < 0.01) and psychological well-being (p < 0.05), adjusting for age and gender. Conclusions: Resilience plays a crucial role in improving both educational satisfaction and psychological outcomes in nursing students. Integrating resilience-building strategies into nursing curricula could enhance learning experiences and well-being.

Nursing Reports doi: 10.3390/nursrep16040119

Authors: Helene Åvik Persson Anders Palm Karin Samuelson

Background/Objectives: Contemporary healthcare systems are characterised by rapid change, high workload, and staff shortages, creating conditions that may compromise care quality and generate turbulence in nursing. Turbulence has been discussed in nursing research. However, greater conceptual clarity is needed regarding its underlying factors and implications for nursing work. The aim of this study was to explore and analyse the concept of turbulence in nursing and its related factors. Methods: The study was conducted using the Simultaneous Concept Analysis Method involving a consensus group and a nursing care, expert group and included content validity index ratings as a validation technique. Results: Eight factors related to turbulence in nursing were identified. A conceptual model was developed to illustrate the interrelationships among these factors and their role within the turbulence concept. Based on this model and the demonstrated contextual interconnections, a comprehensive definition of turbulence in nursing was formulated. Conclusions: The study has achieved a deeper understanding of the concept “turbulence in nursing” through the identification of eight different, generally valid turbulence-related factors and their presumed impact on nursing care. A conceptual model of interacting forces in turbulence in nursing has been presented as both a detector and a compass for mapping and counteracting future tendencies toward turbulence in the work environment. The study enables healthcare professionals and leaders to detect and address emerging turbulence in nursing practice and education. By clarifying its underlying major related sources, the model serves as a practical guide for improving the work environment, strengthening team resilience, and ultimately enhancing patient safety and quality of care.

Nursing Reports doi: 10.3390/nursrep16040118

Authors: Mafalda Inácio Maria Carvalho Ana Paulino Patrícia Costa Ana Rita Figueiredo Elisabete Nunes Paulo Cruchinho Pedro Lucas

We would like to thank the author of the comment on our article [...]

Nursing Reports doi: 10.3390/nursrep16040117

Authors: Marlene Patrícia Ribeiro Renata Cristina Gasparino Olga Maria Pimenta Lopes Ribeiro

Background/Objectives: Professionalism reflects an individual’s connection, identity, and dedication to their profession. In nursing, it is associated with quality of care and professional respect, making its assessment essential for workforce development and management. However, valid and reliable instruments are needed to measure this construct across cultural contexts. Therefore, this study aims to evaluate the validity and reliability of the Portuguese version of the Nurses’ Professionalism Inventory (NPI). Methods: This methodological study used cross-sectional data collected from November 2024 to January 2025 in northern Portugal. Data were gathered from a convenience sample of 684 nurses who completed a sociodemographic questionnaire, the Portuguese NPI, the Conditions of Work Effectiveness Questionnaire II (CWEQ-II), and the Team Psychological Safety (TPS) scale. Confirmatory Factor Analysis (CFA) was conducted. Factor loadings and Average Variance Extracted (AVE) were used to assess validity. Internal consistency was evaluated using Composite Reliability, McDonald’s omega, and Cronbach’s alpha. Convergent validity was examined using Spearman correlations among NPI subscales, CWEQ-II dimensions, and TPS. Results: The Portuguese version of NPI preserved the original five-factor structure. The model showed acceptable fit indices (TLI = 0.90; CFI: 0.91; RMSEA = 0.10; SRMR = 0.08). All items had factor loadings above 0.50, except item 18 (0.42), which did not load significantly on any other factor; therefore, it was removed. This improved the AVE of the Professional Attitude subscale. The overall internal consistency was satisfactory, with all reliability coefficients ranging between 0.73 and 0.99. The correlations among the NPI subscales, CWEQ-II dimensions, and TPS were positive and statistically significant. Conclusions: This study demonstrates adequate measurement properties of the Portuguese version of NPI, supporting its use as a valid and reliable instrument.

Nursing Reports doi: 10.3390/nursrep16040116

Authors: Abdellah Selmi Zakaria Belrhiti

Background: Nurses’ motivation is essential for ensuring the quality of care and workforce retention. Understanding the underlying psychological mechanisms is essential, particularly through Self-Determination Theory (SDT). This approach clarifies how work environments influence work engagement and performance. Existing research has explored SDT in various contexts. However, little is known about how contextual and organizational factors specifically impact nurses’ motivation in low- and middle-income countries such as Morocco. This study contributes to addressing this gap. Objectives: This study explores how organizational factors within a Moroccan university hospital influence the BPNs’ satisfaction in a Moroccan teaching university hospital. Methods: An exploratory qualitative case study was used. Purposive sampling was used to select 26 participants, including nurse managers (n = 7), rehabilitation therapists (n = 5), pharmacy technicians (n = 4), nurses at the Hematology Department (n = 4), nurses at the Emergency Department (n = 4), and nurses in the outpatient consultation unit of the Otorhinolaryngology Department (n = 2). Data collection was conducted from March to June 2023, following ethical approval. Data analysis followed Yin’s five-step process, incorporating deductive and inductive coding, within- and cross-case thematic analysis, and iterative explanation-building. Results: Identified motivation emerged as the most frequently reported type, although BPNs’ satisfaction varied. Rehabilitation therapists consistently reported high levels of autonomy, competence, and relatedness, which were attributed to transformational leadership, task specialization, and a supportive organizational culture. In contrast, nurses experienced role ambiguity, transactional leadership, excessive workloads, and limited autonomy in decision-making, all of which contributed to unmet BPNs. Performance evaluations and financial incentives were widely perceived as unjust. Conclusions: This study shows that in LMIC hospital settings, nurses’ motivation depends on organizational support for their BPNs, especially in resource-constrained environments. The significant disparities between professions within hospitals indicate that supportive environments with autonomy-supportive leadership, clear roles, fair evaluation, and adequate staffing are both achievable and essential for motivating and retaining nurses.

Nursing Reports doi: 10.3390/nursrep16040115

Authors: Jiri Remr

Background/Objectives: In the context of nursing research and interventions, caregiver preparedness emerges as a pivotal concept. Informal caregivers play a central role in providing older adults with the vital nursing and social support they require. The present study evaluated the psychometric performance of the Caregiver Preparedness Scale (CPS) and tested the hypothesis that CPS scores differentiate between theoretically relevant known groups, including caregiving exposure and relationship-based indicators. Methods: A cross-sectional, face-to-face survey was conducted in June 2025 among the general population of Czechia. A total of 1024 interviews were included in the analysis. The sample was randomly split for exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The internal consistency of the scale was assessed using Cronbach’s α and McDonald’s ω, while inter-item associations were evaluated with Kendall’s tau-b. The known-groups validity was assessed through nonparametric group comparisons across caregiving exposure, relationship indicators within the caregiver–senior dyad, caregivers’ self-rated health, and their life satisfaction. Results: The CPS demonstrated high internal consistency (Cronbach’s α = 0.944; McDonald’s ω = 0.944), robust item–total correlations (0.730–0.863), and acceptable floor and ceiling effects. The EFA supported a dominant one-factor solution (eigenvalue = 5.749), which explained 71.9% of the variance and had strong loadings (0.750–0.894). The CFA demonstrated a good fit (RMSEA = 0.069, SRMR = 0.0155, CFI = 0.990, and TLI = 0.980) after allowing for a limited number of conceptually justified residual covariances. Known-groups analysis supported the sensitivity of the scale when the CPS scores were higher among primary (M = 25.30) and secondary (M = 22.73) caregivers in comparison to non-caregivers (M = 18.38). Moreover, statistically significant differences were observed among those who provided care during the past five years (M = 24.30) compared to those without such experience (M = 18.12). CPS scores also exhibited variation in relationship-focused indicators in the anticipated directions, and were lower among respondents reporting poorer health and lower life satisfaction. Conclusions: The study provided consistent evidence that CPS is a reliable, unidimensional measure with robust known-groups validity. The CPS can be regarded as a suitable research instrument for nursing research and for evaluating interventions aimed at supporting informal caregivers.

Nursing Reports doi: 10.3390/nursrep16040114

Authors: Giovanni Cangelosi

I have read the article entitled “Nursing Practice Environment in the Armed Forces: Scoping Review” by Inácio et al [...]

Nursing Reports doi: 10.3390/nursrep16040113

Authors: Pardis Momeni Elisabeth Winnberg

Background/Objectives: Parkinson’s disease (PD) is a progressive neurodegenerative disorder that affects both motor and non-motor functioning, leading to increasing dependency and long-term psychosocial consequences. As the disease progresses, partners often assume caregiving roles, resulting in shifts in responsibilities, communication patterns, and emotional dynamics within marital relationships. The aim of this study was therefore to explore the impact of Parkinson’s disease on marital relationships. Methods: A qualitative interview study with a retrospective design was conducted. Six couples were recruited through a movement disorders clinic and a lay organization in Sweden. Semi-structured, face-to-face interviews were conducted separately with each partner. Interviews were transcribed verbatim and analyzed using conventional content analysis with an inductive design. Results: Four main themes emerged: managing the disease together in partnership, nurturing the relationship, facing marital hardship, and planning an uncertain future. Couples who adopted a positive and pragmatic outlook, shared responsibilities, and maintained open communication seemed to be better able to manage the disease. Engaging in joint activities and reciprocal communication strengthened emotional closeness. In contrast, changes in roles, emotional distress, loss of intimacy, and communication avoidance challenged relationships. Thinking about the future evoked feelings of ambivalence, as couples balanced uncertainty with a need for security. Conclusions: Parkinson’s disease affects marital relationships, reshaping roles, emotional bonds, and future perspectives. The ability of nurses to address both partners’ needs and promote communication and shared coping strategies is essential to strengthening couples’ well-being.

Nursing Reports doi: 10.3390/nursrep16040112

Authors: Sebastjan Merlo Iztok Podbregar

Background: Job satisfaction among nursing staff is a key determinant of workforce stability, quality of care, and healthcare system sustainability. Nurses are increasingly exposed to high workload, staffing shortages, and complex organizational demands, which may adversely affect satisfaction and retention. The aim of this study was to examine job satisfaction among nursing staff working across different levels of healthcare in Slovenia and to identify organisational and sociodemographic factors associated with job satisfaction. Methods: A cross-sectional quantitative study was conducted among nursing staff employed in Slovenian healthcare settings. Data were collected using an online questionnaire that included the Job Satisfaction Survey (JSS) and sociodemographic, occupational, and organizational variables. Differences in job satisfaction across professional groups were examined using non-parametric tests. Associations between job satisfaction dimensions and explanatory variables were analysed using Spearman’s correlation coefficients, and multiple linear regression analyses were performed to identify independent predictors of job satisfaction. Results: Organizational and workload-related factors emerged as the most consistent determinants of job satisfaction across all JSS dimensions and total satisfaction. Unclear job task definitions, high workload, insufficient staffing, continuous healthcare provision, unfavourable work schedules, and limited opportunities for rest were associated with lower job satisfaction. In contrast, financially compensated overtime, supportive supervision, higher perceived employer quality, longer tenure in the current position were associated with higher satisfaction in several domains. Sociodemographic variables showed weaker and less consistent effects after adjustment for organizational characteristics. Intentions to change jobs within or outside the healthcare system were strongly associated with lower satisfaction across nearly all dimensions. Conclusions: Job satisfaction among nursing staff is shaped predominantly by modifiable organizational factors rather than demographic characteristics. Interventions aimed at improving task clarity, staffing adequacy, work organization, leadership practices, and recovery opportunities may enhance job satisfaction and contribute to a more sustainable nursing workforce.