Nursing Reports doi: 10.3390/nursrep16090338

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

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

Nursing Reports doi: 10.3390/nursrep16090337

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

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

Nursing Reports doi: 10.3390/nursrep16090336

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

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

Nursing Reports doi: 10.3390/nursrep16090335

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

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

Nursing Reports doi: 10.3390/nursrep16090334

Authors: Sang Un Park So Young Choi

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

Nursing Reports doi: 10.3390/nursrep16090333

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

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

Nursing Reports doi: 10.3390/nursrep16090332

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

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

Nursing Reports doi: 10.3390/nursrep16090331

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

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

Nursing Reports doi: 10.3390/nursrep16090330

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

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

Nursing Reports doi: 10.3390/nursrep16090329

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

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

Nursing Reports doi: 10.3390/nursrep16090328

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

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

Nursing Reports doi: 10.3390/nursrep16090327

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

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

Nursing Reports doi: 10.3390/nursrep16090326

Authors: Fatma Magdi Ibrahim

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

Nursing Reports doi: 10.3390/nursrep16090325

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

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

Nursing Reports doi: 10.3390/nursrep16090323

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

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

Nursing Reports doi: 10.3390/nursrep16090324

Authors: Wakako Yachi

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

Nursing Reports doi: 10.3390/nursrep16090322

Authors: Ayano Ando Runa Tokunaga Takahiro Mihara Makoto Kaneko

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

Nursing Reports doi: 10.3390/nursrep16090320

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

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

Nursing Reports doi: 10.3390/nursrep16090321

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

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

Nursing Reports doi: 10.3390/nursrep16090319

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

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

Nursing Reports doi: 10.3390/nursrep16090318

Authors: Erica Blumenstock Debra Penrod Heather Brown

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

Nursing Reports doi: 10.3390/nursrep16090317

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

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

Nursing Reports doi: 10.3390/nursrep16090316

Authors: Domonkos Tinka Mohammad Milad Shafaie

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

Nursing Reports doi: 10.3390/nursrep16090315

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

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

Nursing Reports doi: 10.3390/nursrep16090314

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

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

Nursing Reports doi: 10.3390/nursrep16090313

Authors: Jun Okuda Yoshiyuki Takashima

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

Nursing Reports doi: 10.3390/nursrep16090312

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

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

Nursing Reports doi: 10.3390/nursrep16090311

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

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

Nursing Reports doi: 10.3390/nursrep16090310

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

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

Nursing Reports doi: 10.3390/nursrep16090309

Authors: Zhe-Ning Yu Tai-Chu Peng

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

Nursing Reports doi: 10.3390/nursrep16090308

Authors: Jeaneth Linki Matsimbi Maditobane Robert Lekganyane

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

Nursing Reports doi: 10.3390/nursrep16090307

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

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

Nursing Reports doi: 10.3390/nursrep16090306

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

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

Nursing Reports doi: 10.3390/nursrep16090305

Authors: Rafael Henrique Marinho Edmundo Martins Junior Geraldo Magela Salomé

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

Nursing Reports doi: 10.3390/nursrep16090304

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

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

Nursing Reports doi: 10.3390/nursrep16090303

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

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

Nursing Reports doi: 10.3390/nursrep16090302

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

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

Nursing Reports doi: 10.3390/nursrep16090301

Authors: Åse Margrete Sagen Geir Egil Eide Tore Grimstad Marit Hegg Reime

Background/Objectives: Psychological distress, including symptoms of anxiety and depression, is common among individuals with inflammatory bowel disease (IBD) and may adversely affect well-being and disease management. However, routine assessment of mental health is not consistently integrated into clinical care. This study assessed the prevalence of anxiety and depression among patients newly diagnosed with IBD at diagnosis and after three months of treatment and explored associations between psychological symptoms, disease activity, and clinical characteristics. Methods: This prospective cohort study included 304 adults newly diagnosed with IBD and treated at Stavanger University Hospital between 2012 and 2019. Symptoms of anxiety and depression were assessed using the Hospital Anxiety and Depression Scale at baseline and after three months. Disease activity was evaluated using the Harvey–Bradshaw Index and Partial Mayo Score. Clinical variables included C-reactive protein, faecal calprotectin, folate, cobalamin, and body mass index. Multivariable regression analyses were conducted to identify factors associated with psychological symptoms. Results: The prevalence of anxiety decreased from 29.8% at diagnosis to 21.6% after three months, while the prevalence of combined anxiety and depression declined from 22.2% to 16.3%. The prevalence of depression alone remained stable over time. Higher disease activity, particularly as measured by the Harvey–Bradshaw Index, showed the strongest association with anxiety and depressive symptoms. However, after adjustment for potential confounders, no significant improvement in psychological symptoms was observed, suggesting that the association between time and HADS scores may be explained by changes in one or more measured covariates. Conclusions: Psychological symptoms remained common during the first months following an IBD diagnosis and were closely associated with disease activity. Medical treatment alone was insufficient to achieve meaningful improvements in mental health outcomes. These findings highlight the importance of systematic psychological assessment, early identification of emotional distress, and integrated multidisciplinary care, including nursing-led screening and supportive interventions, for individuals newly diagnosed with IBD.

Nursing Reports doi: 10.3390/nursrep16090300

Authors: Camilla Ripari Silvia Cilluffo Barbara Bassola Rosario Caruso Stefano Terzoni Maura Lusignani

Background: Although nurses’ health-related quality of life (HRQoL) is critical for mitigating the growing intention to leave the profession, the association between nurse–patient mutuality and nurses’ HRQoL remains unexplored. Therefore, this study aims to examine the association between nurse–patient mutuality and nurses’ HRQoL. Methods: A cross-sectional, multicentre study was conducted across four tertiary hospitals in Italy. Data were collected from a sample of 726 nurses working in medical and surgical inpatient and outpatient wards. Mutuality was measured using the Nurse–patient Mutuality in Chronic Illness scale, comprising three dimensions: developing and going beyond, being a point of reference, deciding and sharing care; HRQoL was assessed via the Short Form-12 Health Status Questionnaire (SF-12), providing Physical (PCS) and Mental (MCS) Component Summaries. Two multiple linear regression models were conducted to evaluate the impact of mutuality dimensions on HRQoL components. Results: Among the 726 participants, none of the three mutuality dimensions were significantly associated with physical HRQoL (PCS). Conversely, two mutuality dimensions were significantly and positively associated with higher MCS scores: developing and going beyond (B = 0.54, 95% CI [0.14, 0.95], p = 0.009) and being a point of reference (B = 0.38, 95% CI [0.09, 0.68], p = 0.010). However, the overall regression model demonstrated a modest explanatory value for MCS (R2 = 0.075). Among covariates, female sex (ref: male; B = −2.29, 95% CI [−4.10, −0.49], p = 0.013) and taking care of relatives (B = −2.07, 95% CI [−3.55, −0.60], p = 0.006) were associated with lower MCS, whereas older age (B = 0.17, 95% CI [0.01, 0.34], p = 0.039) was related to higher MCS. Regarding physical health (R2 = 0.261), having chronic conditions (B = −5.08, 95% CI [−6.48, −3.69], p < 0.001), previous experience as a patient (B = −1.88, 95% CI [−3.07, −0.69], p = 0.002), and taking care of relatives (B = −1.49, 95% CI [−2.62, −0.36], p = 0.010) were significantly associated with lower PCS scores. Conclusions: The reciprocal nature of mutuality could be a potential relational resource for nurses’ mental HRQoL. Healthcare organizations should prioritize structural frameworks and interventions that allow nurses the time and resources to cultivate these essential clinical connections.

Nursing Reports doi: 10.3390/nursrep16090299

Authors: Megan Dale Maude Chapman Caryn West

Background/Objectives: Nursing involves repeated exposure to emotionally, morally, and psychologically distressing experiences, yet the mechanisms through which low-intensity occupational stressors accumulate and contribute to psychological harm remain conceptually unclear. This scoping review examined how the nursing literature conceptualises the cumulative effects of repeated occupationally distressing experiences and identified the conceptual gap created by the absence of a unifying term such as micro-trauma. Methods: A scoping review was undertaken to map concepts used to describe cumulative occupational distress in nursing and determine whether any terminology captures the cumulative impact of repeated low-intensity exposures. Searches were conducted across CINAHL, MEDLINE, and Emcare, supplemented by citation searching, Google Scholar, targeted grey literature searching and structured generative artificial intelligence-assisted source identification. Data were extracted using a priori criteria and synthesised narratively. Consistent with Joanna Briggs Institute guidance, quality appraisal was not undertaken. Results: No included publication applied the term ‘micro-trauma’ to nursing or healthcare workers. Seven publications met the inclusion criteria following expanded searching across supplemental pathways. The literature used heterogeneous and overlapping terminology, including burnout, compassion fatigue, cumulative grief, moral distress, workplace trauma, and post-traumatic stress disorder symptomatology, to describe cumulative psychological burden, but none provided a unifying conceptual frame for repeated low-intensity exposures. Conclusions: The current literature does not yet clearly define or consistently apply micro-trauma in nursing, despite evidence that repeated occupational exposures contribute to cumulative psychological burden. This review highlights a conceptual space before end-point conditions such as burnout, compassion fatigue, or post-traumatic stress disorder symptomatology are recognised. Future research should develop and test a clearer conceptual framework for micro-trauma in nursing before it is applied as a distinct unifying concept.

Nursing Reports doi: 10.3390/nursrep16090298

Authors: Maria Cristina Queiroz Vaz Pereira Carolina Miguel da Graça Henriques Amélia Maria da Fonseca Simões Figueiredo Ana Lúcia da Silva João

Background: Resilience is an important resource in nursing education, supporting students in adapting to demanding academic and clinical environments. However, evidence regarding the factors associated with resilience among nursing students remains inconsistent. This study aimed to examine the factors associated with resilience among undergraduate nursing students, with particular emphasis on gender, age, academic progression, institutional context, and selected sociodemographic characteristics. Methods: A cross-sectional quantitative study was conducted with 263 undergraduate nursing students from two higher education institutions in Portugal. Data were collected using the Takviriyanun Resilience Factors Scale, adapted and validated for the Portuguese population. Descriptive and inferential statistical analyses were performed to examine the two dimensions of the scale—Personal and Social Support Skills and Problem-Solving Skills—and their associations with sociodemographic and academic variables. Results: Students reported generally favourable levels of resilience-related factors, with higher scores observed in items reflecting personal responsibility and perceived social support. Comparatively lower scores were observed for items related to calmness and patience, confidence, optimism, and perceived social acceptance. A statistically significant gender difference was found in Problem-Solving Skills, with male students showing higher mean ranks than female students (p = 0.038); however, the effect size was small (r = 0.13). A moderate positive correlation was observed between Problem-Solving Skills and Personal and Social Support Skills (ρ = 0.394, p < 0.001). No statistically significant associations were found between the resilience dimensions and age, year of study, higher education institution, displacement status, place of residence, or religious affiliation. Conclusions: Undergraduate nursing students demonstrated generally favourable levels of resilience-related factors. Personal and Social Support Skills and Problem-Solving Skills were positively associated, suggesting a meaningful relationship between interpersonal resources and problem-solving competencies. Although a small gender difference was observed in Problem-Solving Skills, the findings do not indicate substantial gender-related differences in resilience-related factors. Educational strategies aimed at strengthening problem-solving, adaptive coping, emotional self-regulation, and social support may be relevant throughout undergraduate nursing education. Longitudinal and multicentre studies are warranted to further investigate the factors associated with resilience and to evaluate the effectiveness of resilience-focused educational interventions.

Nursing Reports doi: 10.3390/nursrep16090297

Authors: Dasilva Taci Rocco Mazzotta Manuela Saurini Sajmira Aderaj Alta Arapi Alessandro Stievano Ercole Vellone Gennaro Rocco Maddalena De Maria

Background/Objectives: Multiple chronic conditions (MCCs) are highly prevalent among older adults and require effective collaboration between the patient and caregiver. Mutuality, reflecting the quality of the dyadic relationship, is associated with better self-care and health outcomes. However, the Mutuality Scale (MS) has not been validated on patient–caregiver dyads managing MCCs living in a low–middle-income country (LMIC). Aim: This study seeks to evaluate the structural and convergent validity and reliability of the MS among patient–caregiver dyads managing MCCs living in a LMIC. Methods: A cross-sectional study was conducted on MCC patients and their caregiver recruited from community and outpatient settings. The MS, Self-care of Chronic Illness Inventory (SC-CII) and Caregiver Contribution to self-care Inventory (CC-SCCII) were used for measuring mutuality, patient self-care, and Caregiver Contribution (CC) to patient self-care, respectively. Confirmatory factor analysis (CFA) was performed separately for patients and caregivers to evaluate the original four-factor structure of the MS. Convergent validity was examined through correlations with self-care and CC to patient self-care. Reliability was evaluated using composite reliability and the Global Reliability Index for multidimensional scale. Results: A sample of 406 patient–caregiver dyads was examined. Patients had a mean age of 73.9 (±6.2) years. Caregivers had a mean age of 47.8 (±15.5) years. The four-factor structure was supported in both samples, with acceptable model fit (patients: Comparative Fit Index (CFI) = 0.953 and Root Mean Square Error of Approximation (RMSEA) = 0.078; caregiver CFI = 0.945 and RMSEA = 0.085. The second-order CFA supported a hierarchical structure. Patient and caregiver mutuality scores were strongly correlated (r = 0.778, p < 0.01). Higher mutuality was associated with better patient self-care (r = 0.276–0.479) and CC to self-care (r = 0.174–0.556). Reliability indices ranged from 0.70 to 0.91 for patients and 0.66 to 0.89 for caregivers. Conclusions: The findings support the validity and reliability of the MS for assessing mutuality in patients and their caregivers managing MCCs in an LMIC characterized by limited healthcare resources and formal support. Its use provides empirical support for assessing relationship quality and facilitating dyadic care within this vulnerable population. Future longitudinal studies should evaluate its predictive validity, responsiveness, and measurement invariance across different groups and between patient and caregiver.

Nursing Reports doi: 10.3390/nursrep16090296

Authors: Qingqing Feng Min Liu Tang Tang Lulu Zhang

Background/Objectives: Communication training in undergraduate nursing skills courses is often overshadowed by procedural skill acquisition, leaving limited opportunities for students to develop patient-centered communication skills and engage in reflective learning. This study evaluated a reflection-integrated CICARE communication program embedded in a Fundamentals of Nursing skills course and explored students’ learning experiences. Methods: A quasi-experimental study with an embedded qualitative component was conducted among second-year undergraduate nursing students in China. The quantitative component used a non-equivalent control group design, while reflective journals from the Intervention Group provided qualitative data on students’ learning experiences. Two intact classes were assigned to the Intervention Group (n = 65), and two intact classes were assigned to the Control Group (n = 66). The Intervention Group received an 18-week CICARE-based communication program integrated into skills training, including scenario-based role-play, emotional cue recognition, demonstration videos, feedback, and reflective journals. The Control Group received conventional skills training. Outcomes included communication competence, empathy, professional identity, clinical judgment, and course performance. Analysis of covariance was used to compare post-intervention outcomes after adjustment for baseline scores. Reflective journals from the Intervention Group were analyzed thematically. Results: After adjustment for baseline scores, the Intervention Group showed significantly higher communication competence than the Control Group (adjusted mean difference = 2.699, 95% CI: 0.108–5.291, p = 0.041). Empathy was also higher in the Intervention Group (adjusted mean difference = 3.796, 95% CI: 0.538–7.053, p = 0.023). The between-group difference in professional identity was not statistically significant (p = 0.073). The Intervention Group achieved higher total clinical judgment scores than the Control Group (31.52 ± 5.50 vs. 27.20 ± 6.45, p < 0.001), with significant differences in noticing, interpreting, and reflecting. Course performance was also higher in the Intervention Group. In their reflective journals, students described greater patient-centered awareness, attention to patients’ emotional needs, professional reflection, and motivation for self-directed learning. Conclusions: Integrating CICARE-based communication training with reflective learning may strengthen communication competence, empathy, clinical judgment, and course performance in undergraduate nursing skills education. Further studies with longer follow-up are needed to determine whether the observed differences persist over time and whether professional identity and action-oriented clinical responses improve with longer educational exposure. Registration: This study was not registered.

Nursing Reports doi: 10.3390/nursrep16090295

Authors: Elisabeth M. Weiss Markus Canazei Siegmund Staggl Laura Staller Katharina Kreiger Bernhard Holzner Verena Dresen

Background/Objective: Web-delivered psychoeducational tools offer scalable options for managing elevated stress. Passive psychoeducation that delivers self-guided content without active psychotherapy techniques or homework may be particularly accessible at low costs. The present study examined the acceptability and preliminary effectiveness of a seven-week app-based passive psychoeducational stress-management program in an unselected cohort of nursing students. Methods: In this parallel-group randomized controlled trial (preregistered at the German Clinical Trials Register), 154 nursing students were randomized to either a psychoeducation group (n = 77) or a waitlist control (n = 77). Outcomes were assessed at baseline and post-intervention using the Depression Anxiety Stress Scales–21 (DASS-21). A total of 56 completed the post-test assessment. The intervention group received a new psychoeducational module each week for seven weeks. After each module, participants rated satisfaction and reported adherence and application of content in daily life. The control group received no intervention. Results: Compared with the waitlist control, the intervention group showed a statistically significant reduction in perceived stress from pre- to post-test. Depressive symptoms demonstrated a trend toward improvement, whereas anxiety scores did not change significantly. Acceptability ratings were high and participants reported moderate uptake of strategies and perceived relief. Conclusions: A brief, app-based passive psychoeducational program appears feasible and acceptable for nursing students and can reduce perceived stress. However, the findings of the current study should be interpreted cautiously given the high attrition rate and the absence of long-term follow-up. Further studies with larger samples and replication under conditions of better retention are warranted.

Nursing Reports doi: 10.3390/nursrep16090294

Authors: Sukanya Juntaree Arissara Sukwatjanee Duangduan Rattanamongkolgul

Background/Objectives: Magnetic resonance imaging (MRI) is often supported by structured safety screening and preparation, yet first-time patients may still experience anxiety, claustrophobic distress, loss of control and non-completion. This study aimed to describe the experiences of adults undergoing MRI for the first time and to identify implications for nursing preparation, communication and diagnostic imaging service design. Methods: A descriptive phenomenological study informed by Husserlian philosophy was conducted in the radiology department of a university hospital in Thailand. Eleven adults who underwent first-time MRI were purposively recruited, including eight who completed and three who did not complete the examination; five participants were hospital personnel. Data were generated through in-depth semi-structured interviews, non-participant observation, audio recording and field notes, and were analysed using Colaizzi’s method. Results: Across the four themes, negotiation of control was identified as a descriptive cross-theme pattern grounded in participants’ accounts rather than as a separate interpretive construct. Participants entered MRI seeking diagnostic clarity, encountered a sensory and spatial environment that weakened control, attempted to regain control through coping and communication, and reflected on the support they would need for any future examination. Four interrelated themes were generated: becoming aware of bodily abnormality and accepting MRI; encountering the MRI environment; managing oneself inside the scanner; and reflecting after passing through the experience. Conclusions: The findings suggest that first-time MRI can be experienced as a nursing-relevant care encounter rather than a neutral technical event. Nursing preparation may need to move beyond routine instructions by addressing sensory realities, anxiety and claustrophobia, coping rehearsal, communication options and post-examination reflection. The effects of these strategies on completion and service outcomes require prospective evaluation.

Nursing Reports doi: 10.3390/nursrep16090293

Authors: Sérgio J. C. Figueiredo Daniel J. Cunha Graciele Oroski Paes Mónica C. L. Araújo Maria José S. Lumini Landeiro

Background/Objectives: Digital transformation is a strategic priority for healthcare systems, requiring nurses to develop competencies that enable the safe, effective, and critical use of digital technologies in clinical practice. Understanding nurses’ digital competence profile is essential to inform leadership, education, and workforce development strategies. This study aimed to assess digital competence among Portuguese nurses, examine its relationship with soft skills, and identify priority areas for professional development. Methods: A quantitative, descriptive-correlational, cross-sectional study was conducted with a nationally recruited convenience sample of Portuguese nurses. Data were collected using a Digital Competence Assessment Questionnaire based on the European Digital Competence Framework for Citizens (DigComp) and Soft Skills Inventory. Associations between digital competence and soft skills were analysed using descriptive, inferential, and multivariable statistical methods with IBM SPSS Statistics version 30.0. Results: Based on the exploratory classification of the knowledge/performance score, 52.0% of participants fell within the Intermediate and 27.2% within the Advanced proficiency intervals. Adapting and Coping, Analyzing and Interpreting, and Interacting and Presenting were positively associated with self-reflected digital competence. Multivariable analysis showed that soft skills accounted for a larger proportion of variance in self-reflected digital competence than in the knowledge/performance test score; however, the explanatory value of the latter model was limited. Conclusions: Participants were predominantly classified within the Intermediate and Advanced proficiency intervals, although comparatively lower descriptive performance was observed in Safety. The findings highlight the potential complementary role of technical competencies and soft skills in digital capability and suggest the value of further investigating targeted educational approaches. These findings may inform nursing leadership, education, and workforce-development strategies aimed at supporting digital competence and sustainable digital transformation.

Nursing Reports doi: 10.3390/nursrep16080292

Authors: Shinhi Han Hee Sun Kang Philip Gimber Sunghyun Lim

Background: Generative Artificial Intelligence (GenAI) is increasingly integrated into nursing education, yet structured AI literacy training and ethical guidance remain limited. Consequently, nursing students often rely on informal learning, resulting in variability in AI readiness, confidence, and responsible use. Aims: This study was conducted to examine (1) whether AI literacy was positively associated with AI self-efficacy and AI attitudes and (2) whether AI self-efficacy mediated the relationship between AI literacy and AI attitudes. Methods: A cross-sectional survey using convenience sampling was conducted with 100 prelicensure nursing students in New York City. Data were collected using the AI Literacy Scale (AILS), AI Self-Efficacy Scale (AISES), and Generative AI Attitude Scale (GAIAS). Correlation and path analyses were performed using SPSS and Amos 30.0. Results: The participants had a mean age of 30.25 years, and 71% were women. AI literacy and AI self-efficacy were both positively associated with AI attitudes (all p < 0.001). Path analysis showed that AI literacy significantly predicted AI self-efficacy (β = 0.39, p < 0.001) and AI attitudes (β = 0.28, p = 0.003). AI self-efficacy significantly predicted AI attitudes (β = 0.31, p = 0.001) and partially mediated the relationship between AI literacy and AI attitudes. Conclusions: AI self-efficacy partially mediated the relationship between AI literacy and AI attitudes. Nursing curricula may benefit from structured AI education that integrates guided GenAI practice, case-based learning, and faculty feedback. Such educational frameworks warrant further empirical investigation regarding their potential to foster AI literacy, AI self-efficacy, and positive attitudes toward responsible AI integration, particularly through longitudinal studies assessing subsequent behavioral outcomes.

Nursing Reports doi: 10.3390/nursrep16080291

Authors: Eva Carolina Rodríguez-Huamán María Angustias Sánchez-Ojeda Providencia Juana Trujillo-Muñoz Karima Mezyani-Haddu Irene Hoyo-Guillot Silvia Navarro-Prado

Background: The World Health Organization recommends exclusive breastfeeding for the first six months of life, with continued breastfeeding alongside complementary feeding up to two years or beyond. However, many mothers are unable to meet their breastfeeding expectations, resulting in a significant emotional impact shaped by social, cultural, and occupational factors. Objective: The aim of this study was to explore mothers’ perceptions and experiences of desired but unattained breastfeeding, with particular attention to its cultural–religious dimension. Methods: A qualitative descriptive study within an interpretivist paradigm was conducted between September 2024 and February 2025. Thirty women (15 Christian and 15 Muslim) receiving care from a primary care midwife in a Spanish city in North Africa participated. Data were collected through semi-structured interviews and analysed using inductive thematic analysis following Braun and Clarke’s approach. Results: Four main themes were identified: (1) emotional experiences and feelings, (2) reasons for breastfeeding discontinuation, (3) contextual and structural barriers, and (4) the influence of the social environment and support networks. Although both groups shared emotions such as guilt, frustration, and sadness, some differences were observed in how breastfeeding discontinuation was interpreted and experienced within this sample. Several Muslim participants expressed distress in relation to maternal identity and perceived maternal inadequacy, whereas several Christian participants more frequently emphasised contextual factors such as perceived lack of support or social pressure. Conclusions: The experience of desired but unattained breastfeeding is complex and may be shaped by cultural–religious context alongside individual, social, and structural factors. Integrating a transcultural approach into healthcare provision may improve emotional support and help reduce the burden of guilt and distress associated with breastfeeding discontinuation.

Nursing Reports doi: 10.3390/nursrep16080290

Authors: Corina Vernic Ovidiu Bedreag Dorina Cristina Sulițanu Ion Petre Liliana Ioana Muntean Sorin Ursoniu

Background and Objectives: Digitalization studies often emphasize perceived benefits while overlooking professionals who cannot determine whether digital tools are useful. This study quantified digital hesitancy among anesthesia and intensive-care professionals, examined its relationship with professional role and experience, and compared it with reported barriers and technology use. Methods: A single-centre cross-sectional survey included 161 professionals (80.1% of 201 eligible departmental staff): 55 nurses and 106 physicians. A four-item Uncertainty Index measured inability to appraise digital benefits in patient safety, clinical decisions, management, and education. Barrier Burden and Resource-Efficiency indices were also calculated. Group differences were assessed using nonparametric tests, and predictors of high uncertainty were examined by multivariable logistic regression. Results: Nurses had substantially higher uncertainty than physicians (mean Uncertainty Index 1.60 vs. 0.49, difference 1.11, 95% CI 0.80 to 1.42; p < 0.001), particularly regarding educational and clinical benefits. Reported barriers were similar across professional groups, with technical problems being the most common. Any reported prior use of training simulators, irrespective of frequency or recency, was markedly lower among nurses than physicians (1.8% vs. 47.2%; absolute gap 45.4 percentage points, 95% CI 35.2 to 55.5; p < 0.001). After adjustment, physician status remained strongly associated with lower odds of high uncertainty, whereas overall seniority was not significant. In an exploratory within-nurse analysis, uncertainty was higher among more experienced nurses, reaching its highest level among those with more than 20 years of practice (Spearman ρ = 0.49, 95% CI 0.24 to 0.68; p < 0.001); the seniority bands were small (n = 7 to 18), so this gradient is hypothesis-generating. Conclusions: Digital hesitancy was concentrated among nurses and was distinct from shared technical barriers; within nurses it was higher at greater seniority. Because patient-safety outcomes and intervention effects were not measured, targeted simulator-based training and role-specific feedback should be regarded as hypotheses for prospective evaluation alongside, rather than established alternatives to, generic infrastructure improvements.

Nursing Reports doi: 10.3390/nursrep16080289

Authors: Francesca Gambalunga Viviana Lora Cristina Marzo Simona Molinaro Flavia Pantaleo Roberto Latina Tatiana Bolgeo Federica Dellafiore Fabrizio Petrone Nicolò Panattoni Laura Iacorossi

Background/Objectives: Hidradenitis Suppurativa (HS) is a chronic inflammatory skin disease associated with a significant impairment in patients’ quality of life (QoL). However, evidence on QoL assessment in HS remains fragmented, with heterogeneous instruments and domains reported. This scoping review aimed to map the assessment of QoL in individuals with HS, identify the instruments used, and describe the domains explored. Methods: This scoping review was conducted in accordance with the Arksey and O’Malley framework, as refined by Levac et al. and the Joanna Briggs Institute. A systematic search of six databases was performed between November 2025 and March 2026 to identify studies reporting QoL or patient-reported outcomes (PROs) in individuals with HS. Data were extracted and analyzed using a narrative synthesis approach. Results: A total of 21 studies met the inclusion criteria. HS was consistently associated with substantial QoL impairment across multiple domains, including physical, psychological, social, sexual, and occupational aspects. Symptom burden was a major determinant of reduced QoL, particularly pain, pruritus, malodor, and discharge. A wide range of instruments was used, with the Dermatology Life Quality Index (DLQI) being the most frequently applied. However, most tools did not adequately capture the multidimensional impact of HS. The use of HS-specific instruments was limited, and most studies adopted cross-sectional designs. Conclusions: QoL in HS is markedly compromised, but current assessment approaches are inconsistent and incomplete. Further research using comprehensive, disease-specific instruments and longitudinal designs is needed to better capture disease burden and support patient-centered care.

Nursing Reports doi: 10.3390/nursrep16080288

Authors: Gulbakit Koshmaganbetova Azamat Zharylgapov Arip Koishybaev Nauryzbay Imanbayev Aliya Zhylkybekova

Background: Family caregivers play a central role in supporting people with colorectal cancer (CRC) and often manage complex physical, emotional, and practical demands. However, evidence regarding their experiences and supportive care needs in Kazakhstan remains limited. This qualitative study explored caregiving experiences, caregiving burden, caregivers’ needs, and coping strategies. Methods: A qualitative descriptive design was used, involving semi-structured interviews with 21 family caregivers caring for patients with CRC. Participants were recruited purposively from the Medical Center of West Kazakhstan Marat Ospanov Medical University and outpatient clinics in Aktobe between December 2025 and March 2026. Interviews were audio-recorded, transcribed verbatim, and analyzed using inductive reflexive thematic analysis. Results: Most family caregivers of patients with colorectal cancer were women (95.2%). Five main themes developed: emotional challenges, transformation of daily life, caregiving tasks, caregivers’ needs and support gaps, and coping strategies and resilience. Diagnosis was described as a distressing experience characterized by shock, fear, and uncertainty. Caregiving substantially disrupted employment, financial stability, and family roles, often requiring work adjustment or leaving the workforce. Caregivers reported insufficient preparation for stoma care and expressed a strong need for structured training. Social isolation was common, as both caregivers and patients experienced a shrinking of their social support networks. Despite substantial burden, caregivers described adaptive responses to ongoing emotional and practical demands, and resilience was a prominent theme. Conclusions: Family caregivers of patients with colorectal cancer in Kazakhstan face interconnected emotional, informational, physical, and system-level challenges, while also drawing on resilience. The findings highlight priorities for support, including structured stoma care education, psychological services, recognition of caregivers’ roles, and improved discharge and transitional care.

Nursing Reports doi: 10.3390/nursrep16080287

Authors: Jose-Manuel Cuervo-Menéndez Marta Sánchez-Zaballos María-Carmen Migoya-Méndez Sara Franco-Correia Aida Gámez-Fernández Maria-Pilar Mosteiro-Diaz

Background: Modifiable lifestyle behaviours, including physical activity and smoking, are important determinants of health and may influence the mental well-being of nursing professionals. However, evidence simultaneously examining these factors and their associations with sociodemographic, occupational, and mental health factors remains limited. Objectives: The aim of this study was to analyse the sociodemographic and occupational factors, as well as anxiety and depressive symptoms, associated with smoking status and physical activity among Spanish nursing professionals. Methods: A cross-sectional study was conducted between June and August 2021, including 1216 Spanish nursing professionals. Participants completed an online questionnaire assessing sociodemographic and occupational characteristics, smoking status, physical activity, and symptoms of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS). Bivariate analyses and multivariable logistic regression models identified factors associated with smoking status and physical activity. Results: Overall, 19.0% of participants were current smokers and 49.2% reported physical activity. Self-reported physical activity was positively associated with being a registered nurse, being male, being separated or widowed, living alone, and longer time working in the current service, whereas having children and current smoking were associated with lower odds of being physically active. Current smoking was less likely among older professionals, registered nurses, participants reporting physical activity, and those with anxiety symptoms. Conclusions: Physical activity and smoking showed an inverse association and were related to different sociodemographic and occupational characteristics among Spanish nursing professionals. The inverse association between anxiety symptoms and current smoking was unexpected and should be interpreted with caution. These findings may inform workplace health promotion strategies addressing physical activity and tobacco use together, while considering the specific needs of different professional groups within the nursing workforce.

Nursing Reports doi: 10.3390/nursrep16080286

Authors: Fangyuan Zheng Laura Hynes Richard J. Gray Irene Ngune Jacqueline Sin Martin Jones

Background/Objectives: Chronic pain is a prevalent and complex condition associated with substantial physical, psychological, and social burden. Behavioural activation (BA), a structured psychological intervention originally developed for depression, may be relevant to chronic pain through its focus on reducing behavioural avoidance and increasing engagement in meaningful activities. Although BA has been applied in studies involving people with chronic pain, the safety and effectiveness of BA in this population have not been comprehensively synthesised. This systematic review and meta-analysis will examine the safety and effectiveness of BA for people with chronic pain. Methods: A systematic review and meta-analysis of literature evidence will be conducted. This protocol was developed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) and prospectively registered with PROSPERO (CRD420261379007). Randomised controlled trials (RCTs) evaluating BA or BA-based interventions for individuals with chronic pain will be eligible. MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Emcare, Web of Science Core Collection, Scopus and the Cochrane Central Register of Controlled Trials (CENTRAL), trial registries, and citation tracking will be searched. Two reviewers will independently screen records, extract data, and assess risk of bias using the Cochrane Risk of Bias 2 (RoB 2) tool. Where appropriate, meta-analysis will be conducted using a random-effects model. Pain intensity will be the primary outcome. Reported adverse events and other safety outcomes will be extracted and synthesised. Certainty of evidence will be assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Results: Not applicable; this is a protocol. Findings will be synthesised as specified in the Methods. Conclusions: The review will evaluate the effectiveness of BA with respect to pain intensity among people with chronic pain and examine what is known about its safety based on reported adverse events and other safety outcomes in existing trials. The review is expected to clarify the extent, consistency, and certainty of the randomised evidence on the effectiveness and safety of behavioural activation interventions for chronic pain and to identify gaps in adverse-event reporting and safety monitoring. Findings may inform clinical decision-making, intervention adaptation, and future research on BA for chronic pain.

Nursing Reports doi: 10.3390/nursrep16080285

Authors: Kathleen J. Finlayson Emilia Maria Bran Hernandez Emi Nishiyama Jane O’Brien Christina N. Parker

Background/Objectives: Healthy macrovascular and microvascular circulation is essential for wound prevention and healing in high-risk feet. While validated methods of assessing lower limb macrocirculation exist, microcirculation assessment often relies on subjective clinical judgement. This study aimed to determine reliability and reproducibility of laser speckle contrast imaging (LSCI) of superficial circulation in the feet of adults attending a high-risk foot clinic. LSCI was undertaken on seven regions of the foot, and then repeated 3–5 min later. Methods: LSCI measures were compared to health and clinical measures using correlations, t-tests or ANOVA, as appropriate, and intra-class correlation coefficients (ICC) used to analyse reliability measures. In a sample of 31 participants, good test–retest reliability was found (3–5 min apart), with ICC from 0.94 (95% CI 0.76–0.98) to 0.99 (95% CI 0.96–0.99). Results: A sub-group of 10 participants were available to test reproducibility one week later, with Cronbach’s alpha ranging from 0.83 to 0.97. Lower LSCI perfusion measures were significantly related to longer ulcer duration, use of a walking aid, and presence of respiratory disease or previous cerebro-vascular accident. Conclusions: These findings support the potential role of LSCI as a non-invasive method to evaluate superficial perfusion in high-risk feet.

Nursing Reports doi: 10.3390/nursrep16080284

Authors: Nina Gårevik Petra Löfstedt Lilly Augustine Lise-Lott Rydström Maria Jirwe

Background/Objectives: Young people’s mental health is increasingly discussed using diagnostic terms. However, limited knowledge exists about how young people describe distress and support needs. This study explored how young people with self-reported functional difficulties described challenges affecting their mental health and everyday lives. Methods: A qualitative study was conducted using 137 anonymized chat and text message contacts from BRIS (Children’s Rights in Society), a Swedish youth helpline. Contacts registered within the category “Functional Impairments” were selected through predefined inclusion criteria. The material was analysed in Swedish using Framework Analysis. Results: One overarching theme, Trying to Survive in an Emotional Storm, was identified, comprising three subthemes: Social Environment—Between Norm Pressure and the Need for Support, A Constant Struggle in the Educational System and Insufficient Parental Support—Between Desire for Help and Barriers to Understanding. Young people described challenges related to social relationships, school demands, and limited support from adults. Self-reported diagnostic labels, particularly ADHD, were used to explain and communicate distress. Conclusions: The findings suggest that distress was closely linked to social and contextual circumstances. For nurses and other mental health professionals, the findings highlight the importance of listening to young people’s narratives and supporting participation, autonomy, and meaning-making.

Nursing Reports doi: 10.3390/nursrep16080283

Authors: Siti Zubaidah Mordiffi Xiujuan Guo Mien Li Goh Kee Yuan Ngiam Neng Wei Wong Jenny Chua Mohammad Shaheryar Furqan Han Shi Jocelyn Chew

Background: Falls are the most common hospital-acquired adverse event, leading to extended hospitalization, loss of independence, disability, and premature death. Routine fall risk assessments are time-consuming, even with limited factors. An AI-derived fall prediction model can provide more comprehensive and comparably accurate risk predictions quickly and as often as needed. Objective: To develop and validate a fall prediction model for fall risk in adult inpatients. Methods: Patient records from 2016 were extracted from the adult inpatient database, including information from the Electronic Inpatient Medication Records, SAP, and Hospital Incident Reporting System. The sample consisted of 1506 cases (1:5 faller to non-faller). The fall prediction model was trained using the following four variables: demographics, diagnosis, medications, and surgery. Data sources included the hospital’s data repository, integrating admission/discharge, pharmacy, laboratory, and incident reports. Results: The support vector machine model performed best among all tested models, achieving an AUC of 0.803, recall of 0.816, and precision of 0.440. In the validation cohort (978 patients: 163 fallers and 815 non-fallers), the fall prediction model demonstrated moderate-to-good discrimination (AUC 0.79), with accuracy of 0.67, sensitivity of 0.46, and specificity of 0.86. Compared with the nursing four-item fall risk assessment, which showed lower discrimination (AUC 0.65, accuracy 0.65, sensitivity 0.58, specificity 0.72), the fall prediction model had better specificity and overall discrimination, though the nursing tool was more sensitive in identifying fallers. Conclusions: The fall prediction model using demographics, diagnoses, medication, and surgery data predicts falls risk effectively. It enables timely, accurate risk assessments and supports preventive interventions, saving nurses’ time for direct patient care.

Nursing Reports doi: 10.3390/nursrep16080282

Authors: Francisco Javier Arroyo-Cruz Karina Isabel Casco-Gallardo Edith Araceli Cano-Estrada Benjamín López-Nolasco Abigahid Vianey Morales-Ortiz Claudia Atala Trejo-García José Antonio Guerrero-Solano

Background: Over recent decades, Latin America has undergone significant population aging, accompanied by persistent inequalities that adversely affect healthcare access, particularly among Indigenous populations. This scoping review aimed to map and synthesize the available evidence on healthcare access for older Indigenous women in the region, identifying relevant dimensions, barriers, facilitators, and existing knowledge gaps. Methods: A systematic search was performed in scientific databases and gray literature up to 19 June 2026, including studies published between 2020 and 2026 in Spanish, English, or Portuguese. The PCC framework (Population, Concept, Context) was applied. Following a multi-reviewer selection process involving seven reviewers and data extraction using a standardized matrix, the findings were narratively synthesized in accordance with the PRISMA-ScR guidelines. Results: Eleven sources of evidence were included, representing six Latin American countries and including one regional review; qualitative approaches were the most common among the primary studies. Eight dimensions of accessibility were identified: geographic, economic, cultural, organizational, linguistic, functional, administrative, and social. Principal barriers included geographic isolation, poverty, a lack of cultural and linguistic relevance, bureaucratic hurdles, structural racism, and a scarcity of disaggregated data. Facilitators encompassed family and community networks, traditional medicine, local leadership, social programs, and technological/intercultural adaptations such as telemedicine. Compared with the Levesque framework, approachability, appropriateness, and formal system-navigation mechanisms were not clearly represented in the Latin American evidence, while engagement was insufficiently characterized. Conclusions: The findings indicate that structural and cultural barriers continue to persist.

Nursing Reports doi: 10.3390/nursrep16080281

Authors: Yeowon Jeong Nayoung Kim Seongha Park Jiyun Seok

Background/Objectives: As artificial intelligence (AI) becomes increasingly integrated into healthcare, AI literacy and critical thinking disposition are recognized as important competencies for nursing students in rapidly changing clinical environments. This study aimed to examine the associations of AI literacy and critical thinking disposition with clinical competence among nursing students. Methods: A descriptive cross-sectional study was conducted with 200 nursing students with clinical practice experience who were enrolled in nine nursing colleges located in D City and K Province, Republic of Korea. Data were collected using a structured questionnaire and analyzed using IBM SPSS/WIN 25.0. Statistical analyses included descriptive statistics, t-tests, analysis of variance (ANOVA), Scheffé post hoc tests, Pearson’s correlation coefficients, and multiple regression analysis. Results: Satisfaction with clinical practice (β = 0.35, p < 0.001), critical thinking disposition (β = 0.34, p < 0.001), AI literacy (β = 0.23, p = 0.001), and academic year (β = 0.15, p = 0.009) were significantly associated with clinical competence. The model explained 40% of the variance in clinical competence (R2 = 0.40, adjusted R2 = 0.39, F = 26.11, p < 0.001). Conclusions: The findings indicate that critical thinking disposition and AI literacy were significantly associated with clinical competence among nursing students. Nursing education may therefore consider strategies that address both competencies.

Nursing Reports doi: 10.3390/nursrep16080280

Authors: Pimwalunn Aryuwat Jessica Holmgren

Background/Objective: Family caregivers of individuals with serious mental illness and substance use disorders experience substantial psychological burden. However, emerging evidence suggests many develop resilience and post-traumatic growth despite adversity. This integrative review synthesizes evidence on resilience, coping strategies, post-traumatic growth, and protective factors among these caregivers. Methods: The Whittemore and Knafl integrative review framework guided this synthesis. A systematic literature search was conducted across PubMed, CINAHL, and PsycINFO databases for peer-reviewed articles examining resilience, coping mechanisms, and post-traumatic growth in family caregivers of individuals with serious mental illness and substance use disorders. Qualitative, quantitative, and mixed-methods studies were included. Study quality was assessed using the Mixed Methods Appraisal Tool (MMAT). Data were extracted and analyzed using thematic synthesis to identify common patterns. Results: Multiple protective factors facilitate resilience and post-traumatic growth, including cultural values, family connectedness, religious faith, and emotional intelligence. Individual characteristics such as personality traits and decision-making styles influence adaptation outcomes. Structured interventions including psychoeducation, mindfulness practices, and peer support show initial evidence of enhancing caregiver resilience and psychological well-being, based on a single randomized controlled trial and cross-sectional associations. The caregiving experience provides opportunities for meaningful personal transformation despite significant burden. Conclusions: Family caregivers of individuals with serious mental illness and substance use disorders possess substantial capacity for positive psychological change. Healthcare professionals should implement strength-based, family-centered interventions acknowledging caregiver resilience. Future research employing longitudinal designs and investigating intervention mechanisms is essential to advance caregiver-focused mental health services.

Nursing Reports doi: 10.3390/nursrep16080279

Authors: Kateryna Metersky Rivia Rangel Bryan Koivisto Gilberto Tadeu Reis da Silva Candida Canicali Primo Margareth Santos Zanchetta

Background: Health innovation education often lacks focus on local realities and practitioner-led approaches. An international Canada-Brazil academic partnership was developed to address this gap within Brazil’s Unified Health System. Objectives: This paper examines attendees’ perceptions of a short-term, binational educational intervention and identifies perceived gaps in innovation training within a resource-constrained health system. Design: A qualitative, pedagogically focused program evaluation of a short-term binational educational intervention, using participant reflections and post-course survey responses to examine perceived learning, applicability, and curricular gaps. Settings: Two academic and clinical sites in Vitória and Salvador, Brazil. Attendees: Fifty attendees (30 in Vitória, 20 in Salvador), comprising students, faculty, and health and social care professionals. Methods: The 30 h in-person course was delivered in late November (Vitória) and early December 2025 (Salvador) and addressed ‘wicked problems’ through value proposition development, design thinking, and prototyping. Facilitated by a Canadian faculty with English–Portuguese simultaneous translation. The course’s immediate evaluation used daily reflective exercises and a final participant survey. Results: Respondents’ reflections suggested a perceived reframing of innovation from a primarily technology-oriented concept toward a human-centered, context-responsive, and systems-oriented process. Respondents also identified areas requiring further curricular attention, including financial sustainability, implementation planning, and impact evaluation. Conclusions: Findings from this immediate post-course evaluation suggest that short-term, interprofessional innovation education may support perceived shifts in how participants understand health innovation. However, because the evaluation relied on self-reported, post-course qualitative data without pre/post or longitudinal measures, findings should be interpreted as perceived learning and exploratory curricular insight rather than demonstrated competency development or sustained implementation capacity.

Nursing Reports doi: 10.3390/nursrep16080278

Authors: Jie Zhou Shang Gao Qi Jiang Yiwei Qian Wei Zhao Wenxuan Ding Lei Yang

Background: Early childhood caregivers are exposed to intensive caregiving demands and have a high risk of depression. Guided by the family stress process model and Acceptance and Commitment Therapy (ACT), this cross-sectional study examined whether psychological flexibility mediates the association between parenting stress and depression. Methods: A cross-sectional survey was conducted among 1140 Chinese primary caregivers of infants aged 0–36 months in Ya’an, Sichuan, China, from 9 October 2022 to 8 October 2025 using convenience sampling. Validated scales included the Parenting Stress Index-Short Form (PSI-SF), Acceptance and Action Questionnaire-II (AAQ-II) (Higher AAQ-II scores reflected lower psychological flexibility), and Patient Health Questionnaire-8 (PHQ-8). Hayes’ PROCESS Model 4, with 5000 bootstrap resamples, was adopted for the mediation analysis. Results: Parenting stress was positively associated with depressive symptoms (r = 0.335, p < 0.01) (weak-to-moderate effect size). Psychological flexibility exerted a partial mediating effect between the two variables, and the indirect effect accounted for 45% of the total effect. Caregivers with lower household income, lower educational level, and those caring for children aged 0–12 months reported significantly higher depression (all p < 0.05). Conclusions: Parenting stress is an important risk factor for depression, and psychological flexibility plays a significant partial mediating role in this relationship. ACT-based interventions targeting psychological flexibility may hold implications for depression among early childhood caregivers.

Nursing Reports doi: 10.3390/nursrep16080277

Authors: Tanja Lupieri Martina Hrvačić Dubravka Švob Štrac Suzana Uzun Dunja Degmečić

Background/Objectives: Healthcare staff, especially nurses, face high occupational stress, yet objective biological indicators that complement self-report are not well established. We examined whether metabolic, hormonal and physiological markers act as indicators of stress and relate to anxiety, depression and burnout in nurses and other healthcare workers. Methods: We conducted a cross-sectional study of 300 hospital employees (239 in healthcare, of whom 123 were nurses; 61 non-healthcare) at a Croatian university hospital; of 329 completed questionnaires, 300 (91.2%) met the inclusion criteria and were analysed. Fasting glucose, lipids, thyroid hormones, cortisol, heart rate and blood pressure were measured; psychological status was measured using the 42-item Depression Anxiety Stress Scales (DASS-42), Maslach Burnout Inventory and Zung scale. Analyses used Mann–Whitney and Kruskal–Wallis tests, Spearman correlation, hierarchical logistic regression adjusted for age, sex, smoking and thyroid medication use, and receiver operating characteristic (ROC) analysis. Results: Healthcare workers had more favourable glucose, total and low-density lipoprotein (LDL) cholesterol than the older non-healthcare group (all p ≤ 0.003); because the groups differed substantially in age, these unadjusted differences are descriptive only. Metabolic markers correlated only weakly with distress and burnout. Within healthcare workers, elevated stress was discriminated in univariable analysis by low high-density lipoprotein (HDL) cholesterol (area under the curve (AUC) 0.72), raised triglycerides (AUC 0.67) and glucose (AUC 0.66); however, after adjustment for age, sex, smoking and thyroid medication use, none of the markers remained independently associated with elevated stress. Conclusions: In this relatively healthy hospital workforce, routinely available biological markers showed limited value as standalone indicators of occupational stress; they are exploratory rather than validated biomarkers, and require confirmation in larger, prospective, multicentre studies before they can complement—rather than replace—psychological screening in occupational-health practice.

Nursing Reports doi: 10.3390/nursrep16080276

Authors: Alexandru Ungurianu Virginia Marina

Background: Burnout, defined by emotional exhaustion, depersonalization, and reduced personal accomplishment, is a major occupational health concern among healthcare professionals. Burnout has been linked to depression, anxiety, and medical errors, but its association with suicidality in healthcare settings remains insufficiently explored. Objective: To investigate the association between burnout dimensions and suicidality among healthcare professionals, and to identify occupational and demographic factors influencing this relationship. Methods: A cross-sectional study was conducted among 195 healthcare professionals in Romania, recruited through voluntary participation in an anonymized online survey. Burnout was assessed using an adapted tool inspired by the Maslach Burnout Inventory, while suicidality outcomes included suicidal ideation, self-harm, and suicide attempts. Descriptive statistics were calculated for demographic and professional variables. Pearson correlations and multivariable linear regression analyses, adjusted for age, professional experience, and shift work, were performed to evaluate associations between burnout dimensions and suicidality. Results: Emotional exhaustion (r = 0.42, p < 0.001) and depersonalization (r = 0.37, p < 0.001) were positively correlated with suicidality, while reduced personal accomplishment was negatively correlated (r = −0.29, p = 0.002). In multivariable regression, emotional exhaustion remained the only statistically significant independent predictor of suicidality after adjustment for demographic and occupational characteristics. Younger age and rotating/night-shift work were associated with higher suicidality in unadjusted analyses but were not independent predictors after multivariable adjustment. Strong correlations between burnout dimensions and physical symptoms highlighted the interplay between psychosocial strain and somatic health. Conclusions: Burnout, particularly emotional exhaustion, was independently associated with suicidality among healthcare professionals, while depersonalization demonstrated a significant unadjusted association that did not remain statistically significant after multivariable adjustment. Younger clinicians, shift workers, and those with less experience appear especially vulnerable. These findings emphasize that burnout is a multifactorial construct with both psychological and somatic dimensions, shaped by systemic workplace stressors. These findings support further evaluation of systematic screening, organizational reforms, mentorship programs, and confidential mental health support as potential components of suicide-prevention strategies for healthcare professionals.

Nursing Reports doi: 10.3390/nursrep16080275

Authors: Yari Longobucco Giulia Adriano Giuseppe Pedrazzi Giulia Di Mari Margherita Boschetto Mariagrazia Paoletti Maria Carmela Santarsiero Federica Scola Maria Mongardi

Background: Healthcare-associated infections (HAIs) remain a major patient safety issue, and hand hygiene (HH) is a key preventive measure. Technologies providing immediate visual feedback may support HH training by allowing objective assessment of hand-rubbing technique. Methods: A multicenter quality improvement project was conducted in three hospitals in northern Italy to assess scanner-measured HH performance over time after a standardized HH training program supported by an automated visual feedback scanner, the Semmelweis Hand Hygiene System®. Nurses and nurse aides performed scanner assessments before training (T0) and up to 6–9 months after training (T1–T4). Data included demographic variables, baseline HH knowledge, ring detection, and scanner pass/fail outcomes. Longitudinal changes were analyzed using adjusted generalized estimating equation (GEE) logistic regression models. Results: A total of 292 healthcare professionals participated in the project (69.2% nurses; mean age 42 years; 81.1% female). At baseline, 44.2% failed the scanner assessment, with dorsum areas being the most frequently insufficiently covered, and 36.0% wore rings. Across 2422 scanner assessments, pass rates improved over time. In adjusted GEE models, each additional scheduled month from baseline was associated with higher odds of passing the scanner assessment (OR = 1.18, 95% CI 1.13–1.24, p < 0.001). This association remained significant in the first-scan-only sensitivity analysis (OR = 1.16, 95% CI 1.11–1.21, p < 0.001). The association was also confirmed in a completers-only sensitivity analysis. Ring detection was associated with lower odds of passing, whereas baseline HH knowledge was not independently associated with scanner performance. Conclusions: Scanner-based immediate feedback was associated with improved scanner-measured HH technique over time. However, the quality improvement design, absence of a control group, use of the scanner as both feedback tool and outcome measure, and declining retention across follow-up assessments limit causal interpretation. Scanner-supported feedback may represent a useful adjunct to traditional HH education, but further controlled studies are needed to assess sustainability and real-world HH compliance.

Nursing Reports doi: 10.3390/nursrep16080274

Authors: Piyanut Xuto Daniel Bressington Lawitra Khiaokham Patompong Khaw-on Nantarat Matayaboon Suraphan Sangsawang Nantawan Janta Pradab Sungplipan Suratsawadee Wiangsuwan Sujitra Chaiwatthanakorn Ampaporn Phiwon Kamonchanok Khetwang Ratchaneewan Charuloedphong

Background: Thai obstetric nurses follow WHO gestational weight gain (GWG) guidelines to prevent gestational diabetes mellitus (GDM). However, these Western-derived guidelines misclassify approximately 16% of Thai pregnant women, who carry excess metabolic risk at lower BMI values than Western populations. Objectives: To derive and validate Thai-specific GWG targets using Thai BMI cut-points across five BMI subgroups and assess implications for nursing practice in GDM prevention. Methods: Retrospective cohort study of 1396 Thai singleton pregnancies at a maternal and child hospital (2023–2025). GWG targets were derived as interquartile ranges (P25–P75) from a healthy-outcomes subgroup (n = 706), with validity confirmed by multivariable logistic regression and a 70:30 derivation/validation split. Results: GDM prevalence was 15.8%, with a rising crude trend that was attenuated after accounting for a mid-study change in screening protocol. Provisional Thai-specific GWG targets were underweight/normal weight 11.5–18.0 kg, overweight 9.7–18.0 kg, obesity class I 9.1–16.0 kg, and obesity class II+ 5.8–12.1 kg. Inadequate GWG in obesity class I was associated with a 3.92-fold GDM risk increase (aOR 3.92, 95% CI 2.12–7.24, p < 0.001). Adherence improved from 34.7% (IOM 2009) to 50.2% with Thai-specific targets. Conclusions: These Thai-specific GWG targets are provisional, single-centre pilot estimates. They appear clinically safe and are substantially more achievable than IOM 2009 criteria and are offered to inform BMI-appropriate antenatal counselling and to justify a multi-centre validation study, rather than as ranges that are ready for immediate national adoption.

Nursing Reports doi: 10.3390/nursrep16080273

Authors: Ana Ramos Rita Maurício Sara Pires Susana Mendonça Lúcia Jerónimo Hélder Fonseca Piedade Pinto Anabela Carvalho Idalina Gomes Eunice Sá Carla Nascimento

Background/Objective: Perioperative nursing care encompasses a diverse patient population with varying needs, anatomical and physiological characteristics, and differing levels of vulnerability, demanding specialized knowledge and skills. This study aims to identify key research priorities in perioperative nursing across the lifespan. Methods: A two-round e-Delphi study was conducted across three Portuguese hospitals, involving expert perioperative nurses (87 in the first round and 69 in the second). Participants rated the importance of various research topics on a 5-point Likert scale about six dimensions: (1) professional development and non-technical skills, (2) person-centered care, (3) organizational aspects and work environment, (4) patient and team safety, (5) digital innovation, and (6) patient outcomes and quality of care. Data were analyzed using mean scores, Content Validity Ratio (CVR) for initial validation, and the Coefficient of Variation (CV) to determine the level of consensus. The reporting of this study followed the DELPHISTAR (Guideline for Reporting Delphi Studies) recommendations. Results: A high degree of consensus was achieved (all CV < 0.20). The experts established a consensus on 48 components. The highest-rated priority was nurse burnout and professional satisfaction (Mean = 4.74). This was closely followed by patient safety (Mean = 4.68), team safety (Mean = 4.65), disaster response (Mean = 4.62), and emergency management (Mean = 4.58). Acute pain control and interdisciplinary communication also emerged as critical areas. Topics such as digital innovation and artificial intelligence, while valued, received lower priority scores. Conclusions: The identified priorities should direct funding toward research, education, quality improvement, and health policies. Future studies should focus on developing interventions to promote a favorable perioperative environment and optimize clinical responses to individuals’ conditions, catastrophes, and life-threatening situations across the lifespan.

Nursing Reports doi: 10.3390/nursrep16080272

Authors: Airam Cabrera-Rodríguez Jacqueline Schmidt-RioValle

Background: Informed consent is an essential ethical and legal process that safeguards patient autonomy, integrity, and rights in healthcare. Although it has traditionally been associated with medical practice, the expanding scope of nursing practice and increased professional autonomy require a clearer understanding of nurses’ roles in this process. Given nurses’ continuous and close contact with patients, examining their knowledge, attitudes, and practices regarding informed consent is essential to ensure ethical standards and patient safety. Objectives: This scoping review will map and synthesize the available evidence on the knowledge, attitudes, and practices of general nurses, specialist nurses, resident nurses, and nursing students in relation to informed consent. Methods: This review will follow the Joanna Briggs Institute methodology for scoping reviews and will be guided by the PRISMA-ScR extension. A comprehensive search strategy will be applied to MEDLINE, CINAHL, Web of Science, Scopus, and Cuidatge databases. Quantitative, qualitative, and mixed-methods studies addressing nurses’ knowledge, attitudes, and practices regarding informed consent will be included. Discussion papers, reflective articles, commentaries, letters to the editor, opinion articles, books, book chapters, gray literature, and literature reviews will be excluded. Study selection and data extraction will be performed systematically, and findings will be synthesized descriptively and presented through tables and narrative analysis. Conclusions: This protocol outlines a transparent and reproducible methodology for a scoping review. It will map evidence on nurses’ and nursing students’ knowledge, attitudes and practices regarding informed consent; it will summarize the existing evidence as well. This study was prospectively registered with the Open Science Framework (OSF) on 13 May 2026.

Nursing Reports doi: 10.3390/nursrep16080271

Authors: Chennyfer Dobbins Abi Rached Ana Luiza Oliveira Sinzato Thacyane Samara dos Santos Victoria Dorneles Nery Galiotti Reginaldo Aguiar Irene Mari Pereira Nertila Podgorica

Aim/Objective: To evaluate undergraduate nursing students’ perceptions of the educational design, debriefing quality, satisfaction, and self-confidence associated with a leadership-focused high-fidelity simulation scenario involving the management of a sharps-injury event. Background: High-fidelity simulation provides structured opportunities for undergraduate nursing students to support learning of communication, prioritization, decision-making, teamwork, and leadership-related behaviors. Design: Single-group educational intervention study using post-intervention learner-reported outcomes. Methods: Fourth-year undergraduate nursing students from a public university in Brazil participated in a 15-min leadership-focused high-fidelity simulation involving the management of a sharps-injury event. After the simulation, participants completed validated instruments assessing simulation design, satisfaction and self-confidence in learning, educational practices, and debriefing. Descriptive statistics and exploratory Pearson correlation analyses were performed using complete data from all participants. Results: Fifty-six students participated in the simulation. Overall, participants reported favorable perceptions of the simulation design, satisfaction with learning, self-confidence, educational practices, and debriefing. Exploratory analyses showed positive correlations between satisfaction and active learning, high expectations, and debriefing quality, as well as between self-confidence and active learning, debriefing, and high expectations. Conclusions: Undergraduate nursing students perceived the leadership-focused high-fidelity simulation scenario as realistic, reflective, and educationally valuable. The scenario may represent a useful pedagogical strategy for introducing leadership-related behaviors in undergraduate nursing education. However, because the findings were based on self-reported perceptions collected after a single simulation activity, they should not be interpreted as evidence of objective leadership-related behaviors or transfer of learning to clinical practice.

Nursing Reports doi: 10.3390/nursrep16080270

Authors: Edit Nyergesné Závodi Viktor Simon Krisztina Antónia Bornemissza Borbála Mikos György János Velkey Gusztáv Róbert Stubnya Helga Judit Feith

Introduction: The current shortage in the global nursing workforce underscores the importance of understanding factors associated with career choice and professional retention. This study aimed to identify background profiles among Hungarian Bachelor of Science in Nursing students and to examine their associations with career-choice patterns and perceptions of the Graduate Nursing Residency Program (GNRP). Methods: A cross-sectional online survey was conducted between 1 September 2025 and 1 March 2026 at seven Hungarian higher education institutions. Of 979 questionnaires screened, eight were excluded because of incomplete cluster-analysis data, resulting in an analytical sample of 971 students. Student background profiles were explored using TwoStep cluster analysis. The four-cluster solution was retained on the basis of model-fit change, cluster-size balance, parsimony, and substantive interpretability; the average silhouette value was 0.20, indicating weak separation. Results: Four exploratory profiles were identified: students from families with a university degree (17.3%), students with a rural healthcare orientation (37.3%), urban middle-class students (24.2%), and students with an urban mobility background (21.2%). The timing of career choice differed across profiles (p < 0.001; Cramer’s V = 0.179). Awareness of the GNRP was limited, with 69.7% reporting no prior knowledge. Perceived contribution to professional development differed statistically across profiles (p = 0.033; partial η2 = 0.009), but the effect was small. Conclusions: The findings describe exploratory background profiles and modest associations rather than stable student categories or causal effects. Limited awareness and generally favorable perceptions of the GNRP suggest potential relevance for future communication and evaluation, but the present study does not establish program effectiveness.

Nursing Reports doi: 10.3390/nursrep16080269

Authors: Apinya Chaiwongsa Nantaporn Sansiriphun Patraporn Bhatarasakoon Nonglak Chaloumsuk

Background/Objectives: Postpartum depressive symptoms are a major maternal mental health concern associated with adverse outcomes for mothers and infants. Although biological, psychological, and social factors have been associated with postpartum depressive symptoms, limited evidence has examined their interrelationships within a theoretically grounded framework among Thai mothers. This study aimed to test a hypothesized Stress Process Model of factors associated with postpartum depressive symptoms among Thai mothers using structural equation modeling (SEM). Methods: A cross-sectional study was conducted among 462 Thai mothers attending routine 4–6-week postnatal follow-up clinics at three tertiary hospitals in Northern Thailand. Participants were recruited using proportional allocation and consecutive sampling. Data were collected between April and June 2025 using standardized measures of postpartum depressive symptoms and standardized measures of self-perceived burden, parenting stress, social support, self-esteem, mastery, and coping, together with demographic and clinical data. Data were analyzed using descriptive statistics and SEM. Results: Using the prespecified Edinburgh Postnatal Depression Scale cutoff score of ≥11, 30.95% of participants screened positive for probable postpartum depressive symptoms. The final structural model demonstrated acceptable fit to the data (χ2/df = 2.95, RMSEA = 0.07, CFI = 0.94, TLI = 0.92, and SRMR = 0.05) and explained 65.10% of the variance in postpartum depressive symptoms. Self-perceived burden and parenting stress showed significant positive direct associations with postpartum depressive symptoms, whereas social support showed significant inverse direct and indirect associations. Perinatal complications were directly associated with postpartum depressive symptoms and indirectly associated through self-perceived burden and parenting stress. Mastery also showed a significant inverse indirect association. Conclusions: The findings support theoretically specified associations consistent with the Stress Process Model. Because all variables were assessed concurrently, the identified pathways should be interpreted as statistical associations rather than evidence of temporal ordering or causal mechanisms.

Nursing Reports doi: 10.3390/nursrep16080268

Authors: Yanjing Lv Minyi Li Yang Yue Cynthia Hallensleben Huohuo Dai Hongxia Shen

Background/Objectives: Nursing informatics (NI) competence is becoming increasingly essential for nursing students; however, previous research has largely relied on quantitative surveys and provided limited insights into why positive attitudes may not be accompanied by practical competence. This study examined Chinese undergraduate nursing students’ self-assessed NI competence and qualitatively explored their conceptual understanding, perceptions, and experiences related to NI and digital health. Methods: A convergent parallel mixed-methods design was employed in Guangzhou, China. Quantitative data were collected from 149 undergraduate nursing students across two nursing schools using the Chinese Self-Assessment of Nursing Informatics Competencies Scale (SANICS), whereas qualitative data were gathered from 23 students at one of the participating schools through six semi-structured focus groups. Quantitative data were analyzed using descriptive statistics and exploratory Spearman correlations, while qualitative data were analyzed thematically. Findings from both strands were integrated during interpretation using a joint display matrix. Results: The mean self-assessed NI competence score was 2.78 ± 0.54 (scale 1–5). Among the five SANICS subscales, attitudes toward NI scored highest (4.16 ± 0.76), whereas applied computer skills scored lowest (2.02 ± 0.80), confirming an attitude-competence paradox. Exploratory correlation analyses showed neither year of study nor clinical exposure was significantly associated with the total competence score, although both were negatively associated with attitudes. Three qualitative themes contextualized this paradox: (1) a fragmented conceptual understanding centered primarily on basic functions and tools; (2) positive but cautious perceptions that recognized the value of NI while expressing concerns about humanistic care; and (3) passive skill acquisition, limited hands-on learning, and insufficient awareness of higher-order informatics roles. Conclusions: In this two-school sample, students valued NI but reported limited applied and clinically situated competence. The findings suggest that curricula should move beyond generic computer courses and unstructured exposure toward practice-embedded NI education, including electronic health record simulation, digital documentation, data security, and clinically relevant digital skills.

Nursing Reports doi: 10.3390/nursrep16080267

Authors: Andželika Zavackienė Alina Štukova Gintarė Venckauskytė Asta Mažionienė

Introduction/Objective: Advanced practice nurses (APNs) play an increasingly important role in healthcare systems by expanding access to high-quality, patient-centred care. However, public understanding of the APNs’ role remains limited, particularly regarding their autonomy, leadership, and scope of practice. In Lithuania, APNs represent a relatively new professional group, and to date, no quantitative study has examined public perceptions of their role, competencies, and professional identity. Understanding these perceptions is essential for supporting the successful integration of APNs into the Lithuanian healthcare system. The aim of this study was to examine public perceptions of the role and professional identity of advanced practice nurses (APNs) in Lithuania. Methods: A quantitative cross-sectional research design was employed. Data were collected between October 2025 and January 2026 through an anonymous online questionnaire survey. Participants were recruited using a non-probability convenience sampling strategy. A total of 518 respondents participated in the study (n = 518). Data were collected using the Nursing’s Current Brand Position Scale (NCBPS) and the Nursing’s Desired Brand Position Scale (NDBPS). Data were analysed using descriptive statistics, correlation analysis, and principal component analysis (PCA). Results: The findings revealed that the public evaluates the professional image of advanced practice nurses (APNs) positively. However, it is primarily associated with traditional nursing values, particularly the perception of nursing as “a caring profession” and patient-centeredness. A statistically significant difference was found between the current and desired APN professional image across all evaluated dimensions (overall mean scores: 6.61 ± 1.67 vs. 7.68 ± 1.67; t = −18.426; p < 0.001), with the largest gap observed in perceptions of APNs as patient advocates, educational leaders, and research contributors. The desired image reflects public expectations for APNs to function as autonomous, decision-making professionals who actively represent patients’ interests. A significant positive association was identified between professional image evaluation and trust in APN competencies (r = 0.66, p < 0.001). Conclusions: Participants in the present study generally perceived the professional image of advanced practice nurses (APNs) positively, primarily associating it with caring and patient-centred care rather than leadership and strategic roles. The comparison between the current and desired professional images suggests that respondents expressed higher expectations for the APN role. Respondents reported moderately high trust in APNs, which was significantly associated with perceptions of their professional image.

Nursing Reports doi: 10.3390/nursrep16080266

Authors: Janeth Dula Sónia Nhancale Laurentino Cumbi Orvalho Augusto Maria do Rosário Oliveira Martins Sérgio Chicumbe

Background: Quality perinatal health care depends considerably on health workforce competency. Improving Maternal and Child Health Nurse (MCHN) competency is urgently needed in low–middle-income countries, especially to manage key perinatal conditions related to prevalent poor maternal health outcomes, such as pre-eclampsia and hemorrhage. Objective: This study assesses the competency of MCHNs in addressing severe pre-eclampsia and antepartum hemorrhage. Methodology: A cross-sectional study was conducted from 4 November to 10 December 2022. A structured questionnaire and clinical vignettes concerning severe pre-eclampsia and antepartum hemorrhage were administered to all available MCHNs working at a convenience sample of 80 primary-level health facilities in southern Mozambique. Participant characteristics and competency scores were described using frequency distributions or measures of central tendency, as appropriate. Mixed-effects ordinal regression was used to assess the association between participant characteristics and competency levels. All analyses were performed using Jamovi version 2.6.22 at a 5% significance level. Results: Out of 191 participants, most (61.8%, 118) were mid-level MCHNs, with an average age of 33 years (95% CI: 32.05; 34.2). The majority (82.7%, 158) provided prenatal consultation on the day of the interview, and about half (50.7%, 97) knew the national standards for prenatal consultation. MCHNs scoring above 50 percentage points on competency comprised 44.5% (95% CI: 37.4; 51.6%). A higher level of knowledge about guidelines and equipment was associated with increased odds ratios for having a higher-level competency score (OR = 2.21 for “good” vs. reference “poor” competency; 95% CI: 1.07; 4.57, p < 0.033). Conclusions: About six in 10 MCHNs in Mozambique have poor competency in addressing severe pre-eclampsia and antepartum hemorrhage. The competency level was only associated with knowledge of standards.

Nursing Reports doi: 10.3390/nursrep16080265

Authors: Vanessa Cameron Sara Neil Jamie Jones-Winer Brittany Justice Mary Wackerlin Kristie Young Madeline Paliganoff Morgan Nutt Jessica Snapp Rachel Kromer Sandra F. Simmons

Background/Objectives: The purpose of this nursing-led quality-improvement initiative was to strengthen organizational culture, support staff well-being, and improve patient safety by implementing an evidence-based collaboration model that redefined registered nurse (RN) and unlicensed assistive personnel (UAP) teamwork in acute care settings. Methods: Guided by transformational leadership principles, Nursing Professional Development (NPD) practitioners, nurse directors and managers, and frontline staff collaboratively redesigned communication and workflows. After piloting the process change, expansion occurred across acute care and step-down units through leader-supported team training alongside ongoing rounding, observations, and feedback cycles. The four phases of the EPIS framework of implementation science were used to implement the initiative, and data were collected via direct observation, anonymous staff surveys, and organizational retention and quality reports. Results: Across the seven units in Cluster 1 of the expansion, 335 RNs and 180 UAPs participated. Standardized communication using a structured handover tool increased from 18% to 95% with corresponding improvements in discussions of quality-related measures such as fall risk, turn schedules, and toileting. Patient safety measures exceeded threshold goals for fiscal year (FY) 2026 across falls with harm, pressure injuries, and catheter-associated urinary tract infections (CAUTI). RN and UAP retention demonstrated overall improvement, with RNs exceeding their retention goal and UAPs exceeding their goal by removing a single outlier unit. Perceptions of overall team communication throughout the shift increased for both RNs and UAPs. Conclusions: This initiative exemplifies how uniting transformational leadership with frontline staff empowerment supports inclusion, improved quality measures, and strengthened workforce resilience. This scalable framework for nurse-led transformation fosters belonging, safety, and shared outcomes across organizations.

Nursing Reports doi: 10.3390/nursrep16080264

Authors: Doina Carmen Mazilu Viorica Nedelcu Ilona Voicu Ioana Grigoraș

Background/Objectives: Nurses working in Anaesthesia and Intensive Care Units (AICUs) face high job demands that may negatively affect their well-being and increase turnover intention. In healthcare systems experiencing workforce shortages, such as Romania, understanding these mechanisms is essential for developing effective retention strategies. This study examined the relationship between job demands and turnover intention among Romanian AICU nurses, focusing on the mediating roles of professional fatigue and depressive symptoms. Methods: A cross-sectional survey was conducted among 1001 nurses from the AICUs of 68 Romanian public hospitals. Job demands were measured using a composite index including night shifts, long working hours, schedule changes, exposure to aggressive patients, calls from home, and alarm-related stress. Professional fatigue was assessed as subjective exhaustion after work, depressive symptoms with the Patient Health Questionnaire-9, and turnover intention as the intention to leave the workplace within 12 months. Mediation analyses were performed using PROCESS macro (Model 4) with logistic regression. Results: Job demands were positively associated with turnover intention. Higher job demands predicted increased professional fatigue and depressive symptoms, both significantly associated with turnover intention. Mediation analyses demonstrated significant indirect associations through both professional fatigue and depressive symptoms, indicating partial mediation. Conclusions: Job demands are related to turnover intention among Romanian AICU nurses both directly and indirectly through professional fatigue and depressive symptoms. Retention strategies should address not only workload reduction, but also prevention and coping interventions targeting fatigue and psychological distress.

Nursing Reports doi: 10.3390/nursrep16080263

Authors: Piyanut Xuto Piyaporn Prasitwattanaseree Lawitra Khiaokham Daniel Bressington Patompong Khaw-on

Objectives: Prospective anthropometric data on how women above and below the Asian-specific BMI ≥ 23 kg/m2 cut-off differ across the maternal continuum remain limited. Because these data were collected in 2017–2018, before Thailand’s 2022 adoption of the threshold in antenatal care, this study describes central adiposity indicators in two independent cohorts of Thai women as a pre-implementation baseline. Methods: In this descriptive longitudinal dual-cohort study at a tertiary centre in Northern Thailand, 192 women formed two independent cohorts: Cohort A (pregnancy, from 12 weeks’ gestation; n = 110) and Cohort B (delivery to 24 weeks postpartum; n = 82), with no woman in both. Women were stratified by pre-pregnancy BMI (<23 vs. ≥23 kg/m2). Waist-to-height ratio (WHtR, primary) and mid-upper arm circumference (MUAC, secondary) were measured at seven timepoints and validated against 3D body scanning (r = 0.92–0.99). Results: At 12 weeks’ gestation, the ≥23 kg/m2 stratum had higher WHtR (0.58 vs. 0.49; d = 1.56) and MUAC (32.52 vs. 26.19 cm; d = 1.98; both p < 0.001). Postpartum, the <23 kg/m2 stratum returned to WHtR < 0.50 by Week 8, whereas the ≥23 kg/m2 stratum remained above 0.50 through 24 weeks (0.56 vs. 0.48; p < 0.001). Conclusions: The ≥23 kg/m2 stratum showed higher central adiposity indicators from early pregnancy and, in the separate postpartum cohort, values that remained above 0.50 through 24 weeks. Because the cohorts comprised different women, these patterns are descriptive and cannot demonstrate within-woman retention. They nonetheless suggest the cut-off may identify women who could benefit from earlier antenatal and extended postpartum nursing assessment, pending confirmation in within-woman studies.

Nursing Reports doi: 10.3390/nursrep16080262

Authors: Rafailia Zavrou Andreas Charalambous Evridiki Papastavrou Anna Koutroubas Maria Karanikola

Background/Objectives: While there is an existing body of quantitative data on the psychological and mental burden of suicide-bereaved parents, further qualitative research is needed to explore suicide-bereaved mothers’ living experiences in specific sociocultural contexts, especially in Southern Europe and the Eastern Mediterranean. Given the persistent stigma surrounding suicide in these societies, and the fact that previous research has often overlooked mothers’ perspectives in favor of broader samples of bereaved parents, we explored the psychosocial needs of Greek-speaking suicide-bereaved mothers in the Republic of Cyprus, and their experiences in accessing formal mental healthcare support. Methods: An inductive, secondary content analysis of qualitative data collected through personal semi-structured interviews with ten suicide-bereaved mothers was employed. Results: Participants’ psychosocial needs centered around a “persistent orientation towards protection,” encompassing three interconnected domains: (1) self-protection and the need for acceptance by shielding themselves from stigma, social judgment, and emotional disintegration, (2) ensuring a safe and protective environment for the surviving family by safeguarding the psychological well-being and cohesion of surviving family members, and (3) protecting the posthumous dignity and memory of the deceased child. Rather than seeking formal support, participants overwhelmingly avoided mental health services, citing a lack of empathy, cultural misunderstanding, and fear of further stigmatization. Mental health professionals were often perceived as inadequate or even harmful, undermining participants’ need for protective attitudes, self-reliance and self-respect during bereavement. These responses reflected how stigma and gendered social expectations surrounding suicide shaped participating bereaved mothers’ disengagement from the healthcare system, despite their intense psychological needs. Conclusions: These findings underscored how gendered social expectations, combined with the stigma surrounding suicide, created significant psychosocial barriers to mental health care for women navigating traumatic grief, particularly in sociocultural contexts where suicide remains highly stigmatized.

Nursing Reports doi: 10.3390/nursrep16080261

Authors: Paulo Brois Sofia Rita Marco Serafim Soraia Pereira Fernanda Príncipe Henrique Pereira Liliana Mota

Background: Environmental hygiene in operating rooms is essential for infection prevention, but visual inspection alone may not reliably identify missed cleaning. Aim: To assess the feasibility of fluorescent gel marker monitoring with ultraviolet light, combined with a nurse-led educational and feedback intervention, on the cleaning of high-touch operating room surfaces. Methods: A quasi-experimental, nonrandomized, single-group pre-post study was conducted in five operating rooms of a district general hospital in southern Portugal. Forty-two cleaning episodes and 420 surface assessments were evaluated across three sequential phases: blinded baseline monitoring, post-training monitoring after a 45-min nurse-led workshop, and feedback-based monitoring using an ultraviolet walk-through. The primary outcome was the proportion of surface assessments classified as completely clean. Exploratory Mann–Whitney U tests compared ordinal cleaning outcomes between phases; p-values were nominal and not adjusted for multiple comparisons. Results: Complete cleanliness increased from 44.7% at baseline to 69.3% after training and 89.2% during feedback-based monitoring. The largest observed increases occurred among surfaces with poor baseline performance, particularly anesthesia machine rebreathing bags, IV stands, computer keyboards, and computer mice. Visual inspection identified dust on keyboards and occasional medication residue but missed several surfaces detected by fluorescent marker assessment. Conclusions: Fluorescent marker monitoring with ultraviolet feedback was feasible within the study setting and was accompanied by progressive improvements in the proportion of surfaces classified as completely clean. However, the absence of a concurrent control group precludes attributing these changes exclusively to the intervention. The approach may support nurse-led quality improvement in operating room environmental hygiene.

Nursing Reports doi: 10.3390/nursrep16080260

Authors: Michelle Kahn-John Brinda Sivaramakrishnan Katie E. Nelson Joshuaa Allison-Burbank Nora Bambrick Rita D’Aoust Lisa Dickson Mina Kazemi Deserae Kill Eagle Karan Kverno Jessica Meese Julie Nanavati Tamar Rodney Janai Williams Teresa Brockie

Background/Objective: The Behavioral and Mental Wellness in Indigenous Communities (BMWIC) education program was created to address mental health (MH) resource gaps in the Fort Belknap Community (FBC). Designed to enhance MH literacy, task-shifting capacity, and MH care coordination skills, the FBC partnered with Johns Hopkins School of Nursing (JHSON) to co-develop a culturally aligned MH training program. This protocol outlines the development of the BMWIC curriculum. Methods: Steps 1–5 of the 6-step Collaborative Participatory Adaptation Model (CPAM) guided the development of the BMWIC, including collaboration, review of evidence-based models, cultural adaptation of materials, and the creation of a robust evaluation plan to be conducted. Four courses were ultimately developed on: historical trauma, culturally informed MH screening and care, risk and protective factors and health-related Tribal, state and federal legal jurisdiction in American Indian and Alaska Native (AI/AN) communities. Discussion: The BMWIC development process serves as a prime example of translating community priorities into an educational intervention through a combination of best practices in health science education with Indigenous ways of knowing (IWK). Targeted training and task shifting, such as through the BMWIC, may have the potential to expand MH-related knowledge and strengthen the capacity of community health systems to identify psychological and behavioral concerns early, coordinate care more effectively, and improve access to MH care and resources at the community level. Conclusions: This protocol may be useful for academic-community partnerships creating culturally informed educational programs across disciplines and specialties in service to Indigenous communities. The next steps will involve piloting and evaluating the curriculum and collaborating with healthcare organizations to determine sustainable pathways for scaling the BMWIC where it is most needed.

Nursing Reports doi: 10.3390/nursrep16080259

Authors: Yahia AL-Helih Majeda Al-Ruzzieh Sami Al-Yatim Mohammad Alawneh Saleh Abual-Haija Faten Odeh

Background: Cardiac arrest is a life-threatening event that requires early recognition and timely intervention. In-hospital cardiac arrest (IHCA) may be preceded by clinical deterioration, making competent monitoring, escalation, and resuscitation response essential. Cardiopulmonary resuscitation (CPR) is a key life-saving intervention, but CPR knowledge and skills may decline when healthcare professionals have limited opportunities for practice or exposure to real CPR events. Aim: This study aimed to evaluate CPR competency retention and compare knowledge and skills outcomes between nurses working in critical care and general care units. Methods and Results: A prospective comparative observational cohort study was conducted among 265 registered nurses. All participants were assessed immediately after BLS training, and each participant was reassessed once at an assigned post-training interval of 1, 3, or 6 months. Therefore, the findings represent subgroup comparisons across reassessment intervals rather than individual longitudinal trajectories across all time points. Knowledge was analyzed as a percentage score, while practical skills were analyzed categorically as Pass or Needs Remediation. Lower knowledge scores were observed at the assigned post-training reassessment intervals than at the immediate post-training assessment in both clinical groups, with clearer differences across reassessment intervals in the general care group. Skills competency also showed a higher proportion of nurses needing remediation at later intervals, particularly in the general care group. Conclusions: The findings suggest that CPR competency retention may vary across clinical settings and post-training reassessment intervals. The results support targeted refresher strategies, while acknowledging that causal explanations and individual longitudinal trajectories cannot be inferred from this design.

Nursing Reports doi: 10.3390/nursrep16080258

Authors: Tomomi Suda Piyaorn Wajanatinapart Ni Luh Putu Dewi Puspawati Lisa Kerckhof Sachiko Makabe Anak Agung Istri Dalem Hana Yundari Suparpit Maneesakorn von Bormann

Background/Objectives: We conducted a virtual exchange program (VEP) to facilitate discussions on the Sustainable Development Goals (SDGs) among nursing students in Belgium, Indonesia, Japan, and Thailand and to assess the improvements in international competencies. Methods: In this quasi-experimental study with a pre- and post-test design, students who voluntarily participated in the VEP were compared with a matched group of non-participants. International competencies were assessed using the STRENCO (Strengthening multi-professional competencies in mental health) Competency Assessment Tool, a self-assessment tool. Hence, this analysis is based on self-reported data, which were analyzed using a linear mixed-effects model. Results: The analysis included 29 and 34 students in the intervention and control groups, respectively. A significant interaction effect between group and time was observed for intercultural competence (p = 0.004, 95% confidence interval (CI): [0.18, 0.87]), personal growth (p = 0.013, 95%CI: [0.10, 0.79]), and digital competence (p = 0.020, 95%CI: [0.09, 1.05]). In contrast, the interaction was not significant for language skills (p = 0.168, 95%CI: [−0.10, 0.58]), global engagement (p = 0.716, 95%CI: [−0.28, 0.40]), and international discipline learning (p = 0.058, 95%CI: [−0.02, 0.87]). Conclusions: This SDG-focused VEP involving nursing students from four countries across Europe and Asia provided a structured approach to international exchange education and may have enhanced intercultural competence, personal growth, and digital competence as components of international competencies. This study is expected to explore future VEP-based practices and international exchanges.

Nursing Reports doi: 10.3390/nursrep16080257

Authors: Ana Pérez-Perdomo Sara Pedregosa-Fauste Carlos Martínez-Gaitero Adelaida Zabalegui

Background: Competencies, such as knowledge, critical thinking, and clinical reasoning skills, are the essential individual characteristics required for effectively carrying out nursing duties. The acquisition and assessment of these competencies among nursing students are crucial for their future practice. This study aims to validate the Competency Inventory of Nursing Students in Spanish. Methods: Validation and back-translation into Spanish of the Nursing Competency Inventory of Nursing Students. Results: The sample was collected from the University of Barcelona, Lleida, and Tecnocampus. Most participants (85.3%) were females between 20 and 29, and 45.3% were in their third year. The general answer mean was 6.34 points. Dimension 4 (Clinical biomedical science) obtained the lowest score and dimension 1 (Ethics and accountability) the highest. The content validity index for the entire scale was 0.93. The Kaiser–Meyer–Olkin measure was 0.926. The Spanish version of the scale demonstrated a Cronbach’s alpha of 0.95. Conclusions: The Spanish CINS version is a valid and reliable tool that can be used to evaluate nursing students’ competencies in the Spanish context.

Nursing Reports doi: 10.3390/nursrep16070256

Authors: Kholofelo Lorraine Matlhaba

Background/Objectives: Advancing clinical competence within contemporary healthcare systems requires innovative educational approaches that bridge professional silos. While Interprofessional Education (IPE) is globally recognized as a mechanism to enhance teamwork, its implementation within resource-constrained public health systems marked by historical and structural inequalities remains poorly understood. This study explored the perspectives and experiences of healthcare professionals and clinical educators regarding how interprofessional education (IPE) may contribute to clinical competence in selected South African public hospitals. Methods: A qualitative descriptive design was used. Semi-structured interviews were conducted with 22 purposively selected healthcare professionals and clinical educators from nursing, medicine, physiotherapy, occupational therapy, pharmacy, and social work. Interviews were conducted at selected hospitals following approval from hospital Chief Executive Officers. Data were collected by the researcher and co-researcher who is not part of this manuscript, audio-recorded, transcribed verbatim, and analyzed using thematic analysis. Ethical clearance and institutional permissions were obtained, and informed consent was secured from all participants. Trustworthiness was ensured through credibility, dependability, confirmability, and transferability. Findings: The thematic analysis yielded two primary patterns: (1) the perceived capacity of IPE to enhance clinical decision-making, communication, and collaborative practices; (2) systemic and structural constraints, including rigid professional hierarchies, severe time constraints, and a lack of formally institutionalized opportunities. Conclusions: IPE is perceived as an important contributor to collaborative clinical competence, but its sustainability depends on explicit institutional mandates. These findings imply that hospital managers and curriculum developers must transition from ad hoc interactions to structured, short-duration interdisciplinary platforms to overcome operational bottlenecks.

Nursing Reports doi: 10.3390/nursrep16070255

Authors: Paula Balaguer Escutia Evelin Balaguer López Pablo Garcia Molina

Background/Objectives: Dependency-related skin injuries (DRSIs) are a significant health issue that exacerbates in critically ill patients, as their clinical condition (immobility, hemodynamic instability, use of diagnostic and therapeutic devices, malnutrition, and pharmacotherapy) promotes their occurrence. The objective of this study was to analyze the incidence and characteristics of DRSIs in critically ill patients at a tertiary care hospital. Methods: An observational, descriptive, longitudinal, and prospective study was conducted in the Intensive Care Units of the Hospital Clínico Universitario de Valencia. Data were analyzed using R software (v.4.2.2). The study was approved by the institutional ethics committee, and informed consent was obtained from each patient or family member. Results: The final sample included 139 patients. The incidence of DRSIs was 33.1% (n = 46), with a total of 82 lesions recorded. The mean time to DRSI onset was 9.2 days. Pressure ulcers accounted for 76.8% (n = 63) of the injuries, of which 47.6% (n = 30) were category I. Approximately 40% of the DRSIs were associated with the use of medical devices, primarily endotracheal tubes, non-invasive ventilation, and respiratory support devices. The most frequent locations were the heels, sacrum, and nose. Conclusions: One-third of the patients admitted to the studied critical care units developed one or more DRSIs. The use of clinical devices and high-risk scores on risk assessment scales (EVARUCI and/or Braden) is associated with a greater predisposition to developing these skin injuries.

Nursing Reports doi: 10.3390/nursrep16070254

Authors: Meng-Yuan Li Tao Wang Daniel Terry Haiying Wang Isabella Zhao Jing-Yu (Benjamin) Tan

Purpose: Breast cancer has been recognised as a chronic condition, with survivors experiencing long-term physical and psychosocial effects following treatment. Supporting breast cancer survivors to self-manage their health can optimise health-related quality of life and reduce symptom burden. Self-management education (SME) has been advocated at the policy and programme level in Australian primary care, but its uptake is often limited. This study explores healthcare professionals’ (HCPs) experiences and perceptions of SME in primary care, aiming to identify factors influencing its implementation and to support survivorship care for breast cancer survivors in Australia. Methods: A qualitative descriptive approach was adopted involving in-depth semi-structured interviews. Convenience sampling was used to recruit HCPs across the three primary care clinics in the Greater Brisbane area. The interviews were conducted based on an interview guide. Each interview was audio-recorded and transcribed verbatim. Descriptive content analysis was used to analyse the data. Results: Fourteen participants were interviewed across three primary care settings, including five general practitioners and nine registered nurses. Three categories were synthesised from the data: (1) Meaning and role of SM/SME; (2) Suboptimal SME in current practice; (3) Perceived factors impacting SME delivery in practice. Each category had two to six subcategories for the participants. Conclusions: The findings highlighted the importance and perceived benefits of SME for breast cancer survivors and HCPs in Australian primary care. However, the integration of SME into primary care remained suboptimal due to a combination of systemic, organisational, and healthcare provider factors. Evidence-based resources, particularly guidelines and training, are essential to equip HCPs to effectively integrate SME into routine care for breast cancer survivors.

Nursing Reports doi: 10.3390/nursrep16070253

Authors: Anu Correya Jing-Yu (Benjamin) Tan Xian-Liang Liu Daniel Bressington Leah East Tao Wang

Background/Objectives: Self-management intervention strategies are recommended to address the needs of breast cancer survivors (BCSs) who have cardiovascular diseases (CVDs). Despite the benefits, these strategies are often suboptimally implemented, resulting in inadequate cardiovascular management among BCS with CVDs. The project aims to develop a nurse-led and GP-supported self-management (NGPS) intervention to reduce cardiovascular risks in BCS with CVDs and evaluate its feasibility and potential effects in primary care settings using the double diamond co-design process and the Medical Research Council (MRC) Framework for Developing and Evaluating Complex Interventions. Methods: The study will be conducted in two phases. In phase I, an evidence-based and co-designed NGPS protocol with end-users will be preliminarily developed based on the identified research evidence, relevant theories, practice guidelines and the current practice standards in Australia. The co-design workshop(s) will involve healthcare professionals and BCSs with CVDs to further refine and validate the developed preliminary protocol. In phase II, a one-group pre-post pilot study will evaluate the feasibility of the intervention and study procedures, such as recruitment, retention, adherence, acceptability, and safety as primary outcomes. The study will also preliminarily explore the effectiveness of the intervention such as physiological measures as secondary outcomes to inform a future large-scale trial. Phase II also involves follow-up qualitative interviews to explore participants’ experiences of the pre-post pilot study. The participants will be recruited from primary medical centres in Victoria. Conclusions: The findings will provide a co-designed evidence-based intervention for primary care nurses and General Practitioners (GPs) to promote long-term health outcomes for patients with both breast cancer (BC) and CVDs. Clinical registration: ClinicalTrial.gov (registration No. NCTO7313397).

Nursing Reports doi: 10.3390/nursrep16070252

Authors: Çağla Toprak Eva Kajti Zahra Ebadi

Background: Postoperative pain is a significant continuous clinical problem for patients in surgical units. This study aimed to examine surgical nurses’ attitudes toward the use of non-pharmacological techniques in postoperative pain management and to identify factors associated with these attitudes. Methods: This descriptive and cross-sectional study was conducted between October 2025 and February 2026 with 200 nurses working in the surgical clinics of a private hospital in Türkiye. Data were collected through digital forms by using the Socio-Demographic Data Form and the Attitude Scale Toward Non-Pharmacological Techniques in Postoperative Pain Management. Descriptive statistics, independent samples t-test, and one-way ANOVA were used for data analysis (p < 0.05). Results: Approximately 59% of the nurses were aged 20–29 years, and 65.5% were female. 68% of the nurses used both pharmacological and non-pharmacological techniques in postoperative pain management, and 80% of them believed that non-pharmacological methods were effective. The mean total score obtained from the scale was 48.42 ± 9.70, indicating that nurses had a positive attitude toward the use of non-pharmacological techniques. Mean scores related to non-pharmacological techniques differed significantly according to gender, marital status, educational level, professional experience, and department (p < 0.05). Conclusions: Surgical nurses demonstrated positive attitudes toward non-pharmacological postoperative pain management. Non-pharmacological techniques should be integrated into clinical practice by nurses in pain management.

Nursing Reports doi: 10.3390/nursrep16070251

Authors: Rana Alaseeri Raghad Alshammari

Background/Objective: Social media platforms have become increasingly integrated into nursing students’ academic and daily lives, influencing how health-related information is accessed, evaluated, and shared. At the same time, eHealth literacy has emerged as an important competency for nursing students within contemporary digital healthcare environments. This study aimed to examine the relationship between multidimensional social networking engagement and perceived eHealth literacy among undergraduate nursing students. Methods: A cross-sectional descriptive correlational design was used among undergraduate nursing students (N = 146). Data were collected using an electronic survey that included demographic characteristics, the Social Networking Usage Questionnaire, and the Revised eHealth Literacy Scale. Descriptive statistics, Pearson’s correlation, and linear regression analyses were performed using SPSS version 26. Results: Participants reported moderate-to-high social networking engagement and generally favorable perceived eHealth literacy. A strong positive correlation was identified between SNUQ and eHEALS-R scores (r = 0.75, p < 0.001), with academic use showing the strongest dimension-level association with perceived eHealth literacy. In the adjusted regression model, social networking engagement remained independently associated with perceived eHealth literacy, whereas demographic variables and daily social media use showed no significant associations. Conclusions: The findings suggest that how nursing students engage with digital platforms is associated with their confidence in accessing, evaluating, and applying online health information. Strengthening purposeful and critical digital engagement within nursing education may help prepare students for contemporary digital healthcare environments.

Nursing Reports doi: 10.3390/nursrep16070250

Authors: Jose Miguel Diez-Fernandez Tania Fernandez-Villa Amaia Rodriguez-Badiola Elba Mauriz Carmen Crespo-Martinez Ana Vazquez-Casares

Background/Objectives: The assessment of clinical competencies in nursing education requires valid and reliable instruments, especially for essential procedures such as the placement of a cervical collar in the care of polytrauma patients. The objective of this study was to analyse the psychometric properties of a rubric designed to assess the placement of cervical collars in nursing students in a low-fidelity clinical simulation environment. Methods: A quasi-experimental, cross-sectional study was conducted with 186 undergraduate nursing students, organised into 61 groups, over three academic years (2021–2024). An eight-item rubric was applied, with a four-level Likert scale (1–4). Interrater reliability was analysed using Cohen’s Kappa index (0.418–0.796), internal consistency using Cronbach’s alpha (alpha = 0.753), and the internal structure of the instrument using exploratory factor analysis, applying Varimax orthogonal rotation. Results: Inter-rater reliability showed values ranging from moderate to substantial, with greater agreement observed in items related to the selection of the collar and the position of the medical team, and moderate agreement in those related to technical manoeuvres and immobilisation. The rubric showed adequate overall internal consistency (α = 0.76), with good to very good consistency values in six of the eight items. Exploratory factor analysis identified a two-dimensional structure with a dominant procedural factor (four items) and a second factor associated with clinical judgement (four items). Conclusions: The validated rubric has adequate levels of reliability and internal consistency for evaluating the placement of cervical collars by nursing students. Its application can promote more objective and structured evaluation processes in clinical simulation for nursing students, contributing to the development of essential skills in the care of polytrauma patients.

Nursing Reports doi: 10.3390/nursrep16070249

Authors: Karolina Filipska-Blejder Monika Biercewicz Renata Jabłońska Agnieszka Królikowska Beata Haor Robert Ślusarz

Elder abuse is internationally recognized as a growing problem of the 21st century that requires urgent intervention and action. This review aimed to synthesize evidence on the prevalence and risk factors of elder abuse between 2010 and 2022. A total of 2875 articles were identified through database searches, of which 28 met the inclusion criteria and were included in the final analysis (24 cross-sectional studies, 3 prospective studies, and 1 descriptive study). Reported prevalence rates of elder abuse ranged from 2.2% to 81.2% overall, while studies conducted during the COVID-19 pandemic reported rates ranging from 1.6% to 44.7%. Psychological abuse was the most frequently reported form of violence. The most commonly identified risk factors included low income, low educational level, gender, disability, depression, and—during the COVID-19 pandemic—social isolation. Across most studies, individuals with lower education and women were statistically more likely to experience abuse. The findings indicate substantial variability in the prevalence of elder abuse both before and during the pandemic, with consistently high rates observed. These results highlight the urgent need for improved screening, education, and targeted interventions by healthcare and social service professionals.

Nursing Reports doi: 10.3390/nursrep16070248

Authors: Nancy Milena Sepúlveda-Sepúlveda Carolina Vargas-Porras María Inmaculada De Molina-Fernández Zayne Milena Roa-Díaz

Background/Objectives: Adolescent pregnancy remains a global public health challenge associated with adverse outcomes for both mothers and newborns. This study aimed to use two instruments and several multivariate techniques to identify a minimal set of variables that reproduces the instrument-based classification of adolescent pregnancy risk, while remaining parsimonious with the original instruments. Methods: A cross-sectional, quantitative methodological study was conducted among Colombian schoolgirls, comprising 160 adolescents in the face-validity phase and 319 in the risk-estimation and modeling phase. The IRENE and REND instruments, originally developed to assess the risk of adolescent pregnancy, underwent cultural adaptation, face validity and content validity. Subsequently, the instruments were administered to estimate the risk. Finally, Factor Analysis and Categorical Principal Component Analysis were applied as exploratory dimensionality reduction techniques to identify the most relevant variables for retention, thereby preserving the parsimony of the original versions. Results: Overall, 80.3% of participants were classified as not at risk, while the remainder were classified as at risk by one or both instruments. The results suggest that variables such as who the adolescent lives with, the age at which the adolescent had their first complete sexual intercourse, and how the adolescent would respond to an unplanned pregnancy are factors associated with the instrument-based risk classification. Subsequently, dimensionality reduction and logistic regression analyses identified a small subset of variables that can be used to reproduce the instrument-based classification of adolescent pregnancy risk. Conclusions: The reduced set of variables reproduced the instrument-based risk classification with high internal accuracy. Because the predictors and the outcome derive from the same instruments, these findings reflect internal reproduction of the instrument classification rather than prediction of an observed pregnancy, and they require external validation. Overall, the reduced and optimized set of variables from the IRENE and REND instruments offers a parsimonious approach that reproduces the instrument-based risk classification and that may support rapid screening once validated in independent adolescent samples. The main limitations are the use of a single institution, the non-probabilistic convenience sample, and the absence of an observed pregnancy outcome.

Nursing Reports doi: 10.3390/nursrep16070247

Authors: Marta Regina Cezar-Vaz Clarice Alves Bonow Shester Cardoso Damaceno Rudson Amaral da Silva Geoffrey Obumneme Okoroigwe Gabriela Laudares Albuquerque de Oliveira

Background/Objectives: In rural settings, work, family, and environmental conditions are closely intertwined, requiring Primary Health Care to recognize care needs arising from productive work and everyday family responsibilities. This study aimed to analyze overall and domain-specific levels of perceived workload related to agriculture/fishing and family involvement in the household among rural and small-scale fishing workers, examine associated factors, and discuss analytical implications for nursing care organization in Primary Health Care. Methods: This cross-sectional study was conducted in three island territories in Rio Grande, southern Brazil, following the STROBE guidelines. Data were collected using a structured questionnaire on sociodemographic, family, and occupational characteristics and the NASA Task Load Index (NASA-TLX), applied separately to assess workload related to agriculture/fishing and family involvement in the household. Results: The sample included 146 rural and small-scale fishing workers. Perceived workload could suggest high in both dimensions, with higher levels in agriculture/fishing (mean 84.0 ± 16.5; 89.7% high/very high) than in family involvement in the household (mean 76.1 ± 24.5; 75.4% high/very high). Agriculture/fishing workload perceived could suggest highest scores for overall effort level, temporal demand, and physical demand, whereas family involvement could suggest highest scores for performance-related workload and overall effort level. In the adjusted model, agriculture/fishing perceived workload may be associated with longer daily working time (b = 1.69; 95% CI: 0.82 to 2.56; p < 0.001) and shorter rest time during work (b = −0.05; 95% CI: −0.08 to −0.01; p = 0.011). Perceived workload related to family involvement in the household may be associated with monthly income up to two minimum wages (b = 19.90; 95% CI: 7.78 to 32.10; p = 0.001). The adjusted R2 values were 17.3% and 6.7%, respectively. Conclusions: Perceived workload appears to be related to high levels in both productive and family household contexts. The findings might contribute to providing analytical support for future discussions on nursing care organization in Primary Health Care, potentially by considering working conditions, family responsibilities, and territorial context when discussing care needs among rural and small-scale fishing workers.

Nursing Reports doi: 10.3390/nursrep16070246

Authors: Deanna Thompson Christine Hodgson Timian M. Godfrey Ruth E. Taylor-Piliae

Background/Objectives: Human trafficking is the use of force, fraud, or coercion to compel a person to provide labor or sex and has become a public health crisis. This scoping review aimed to identify known risk factors for trafficking among North American Indigenous women and to synthesize the complexities of trafficking and its related health outcomes. Methods: Following the PRISMA-ScR checklist, a comprehensive literature search of seven electronic databases (CINAHL, Embase, PubMed, SCOPUS, PsycINFO, Cochrane Library, and Google Scholar) was conducted in March 2022 and updated in September 2023. English language research reports, literature reviews, dissertations and theses, commentaries, and government reports that focused on human trafficking in North American Indigenous women aged 18 years and older from the United States and Canada were identified using key terms. Results: Fifteen articles were included, revealing three themes: structurally produced vulnerabilities and other contributors to human trafficking, the long-term effects of human trafficking, and the need for collaboration of key stakeholders to mitigate human trafficking. Risk factors of human trafficking for Indigenous women include personal factors, historical trauma, and inadequate systems to identify and support victims. The needs of this population are complex. However, a multidisciplinary approach can be effective in combatting human trafficking. Conclusions: This review substantiates key risk factors and complexities unique to the trafficking experienced by North American Indigenous women, while also revealing a persistent gap in the research. These findings advance nursing knowledge by informing culturally responsive, trauma-informed care approaches while supporting targeted educational and research initiatives to improve health outcomes among these women.

Nursing Reports doi: 10.3390/nursrep16070245

Authors: Khulud Adel Abudawood Rawan Almutairi

Pain is highly prevalent during hospitalization, and inadequate assessment contributes to avoidable suffering, prolonged length of stay, and increased resource use. Nurses play a central role in pain assessment, timely analgesic administration, patient education, and escalation of care. Background/Objectives: This study assessed nurses’ knowledge and attitudes regarding pain assessment and management and examined perceived causes of delayed pain treatment and perceived barriers to timely pain control at a tertiary hospital in Saudi Arabia. Methods: A descriptive cross-sectional study was conducted in inpatient and outpatient departments at King Abdulaziz Medical City, Jeddah, Saudi Arabia (August–December 2023). Registered nurses providing direct patient care were recruited via convenience sampling. Data were collected using a demographic and clinical practice questionnaire, the Nurses’ Knowledge and Attitudes Survey Regarding Pain (NKASRP), and an adopted instrument assessing perceived causes of delayed pain treatment and perceived barriers. Data were analyzed using descriptive statistics, two-tailed t-tests, one-way ANOVA with assumption checks and post hoc testing, Pearson correlations, and multiple linear regression. Results: A total of 125 nurses participated; 95.2% were female and 80.8% held a bachelor’s degree. The mean NKASRP composite score was 46.69% (SD = 9.90), indicating a suboptimal knowledge-and-attitudes profile. Age group was significantly associated with NKASRP scores (F = 5.136, p = 0.007), and age remained the only significant independent predictor in the multivariable model (b = 0.055, p = 0.006). The most frequently perceived delay was contacting a physician for opioid prescription (58.4%), followed by obtaining opioids from the pharmacy (46.4%). Major perceived barriers included insufficient staff–patient communication (60.0%), insufficient patient knowledge of pain control (52.8%), and inadequate staffing (49.6%). Conclusions: Nurses demonstrated a low composite knowledge-and-attitudes score and reported communication, workflow, and system-related barriers relevant to timely analgesia. These findings support further prospective evaluation of targeted educational and system-level strategies in similar settings.

Nursing Reports doi: 10.3390/nursrep16070244

Authors: Omar Portela dos Santos Fanny de Hepcée Paulo Jorge Pereira Alves Henk Verloo

Background/Objectives: Climate change is a major global health challenge with direct implications for public health. As frontline health professionals and agents of change, nurses must develop competencies to address climate-related health issues and implement sustainable practices. This study aimed to translate and culturally adapt the Climate, Health, and Nursing Tool (CHANT) into French and to assess its content validity using item-level and scale-level content validity indices (I-CVI and S-CVI, respectively). The CHANT evaluates nurses’ awareness, motivations, concerns and self-reported behaviours related to climate change. A secondary objective was to examine potential associations between experts’ sociodemographic and professional characteristics and their CVI ratings. Methods: A descriptive international study using a three-round modified e-Delphi approach was conducted between January and June 2025 in French-speaking regions of Switzerland, France and Belgium. A multidisciplinary panel of experts in nursing, planetary health and environmental sciences evaluated the relevance, clarity and comprehensiveness of each item and response option, enabling iterative refinement. Results: The original 12-item CHANT was evaluated by 17 experts in Round 1. Following expert recommendations, one additional item was incorporated, resulting in a 13-item version, which was subsequently evaluated by 15 experts in Round 2 and 25 experts in Round 3. Across the three Delphi rounds, 57 completed expert evaluations contributed to the iterative refinement of the instrument. Round 1 I-CVI ranged from 0.79 to 1.0, and S-CVI reached 0.935, with full consensus. Round 2 I-CVI ranged from 0.71 to 1.0, and S-CVI was 0.91 (92% consensus), with one item not meeting the predefined threshold. Round 3 I-CVI ranged from 0.82 to 1.0, and S-CVI returned to 0.935, confirming consensus. A final linguistic, semantic and cultural review conducted by the research team ensured the conceptual consistency and cultural appropriateness of the translated instrument. Conclusions: The French-language version of the CHANT demonstrated satisfactory content validity and provides a culturally adapted instrument to assess climate-related competencies and eco-literacy in nursing education and practice. Further psychometric evaluation is warranted.

Nursing Reports doi: 10.3390/nursrep16070243

Authors: Alfredo Manuli Maria Grazia Maggio Andrea Calderone Lilla Bonanno Provvidenza Tomasello Caterina Pucci Morena De Francesco Gianluca Pucciarelli Rocco Salvatore Calabrò

Background/Objectives: Sexual health is frequently under-addressed after stroke, despite its relevance to intimacy, identity, relationships, and rehabilitation. This convergent mixed-methods study integrated sex-specific screening with descriptive narrative material to examine sexual functioning and patient-reported concerns in clinical rehabilitation. Methods: Twenty-six adults were assessed: ten with the Female Sexual Function Index (FSFI), sixteen with an International Index of Erectile Function six-item field (IIEF-6), and ten with analyzable semi-structured interview responses. The sex-specific measures were analyzed separately. Continuous variables were summarized by median and interquartile range; nonparametric correlations and group comparisons underwent Benjamini–Hochberg false discovery rate correction. Quantitative and qualitative findings were integrated in a participant-level joint display. This integration yielded case-level meta-inferences rather than inferential mixed-methods testing in this sample. Results: Nine of ten FSFI profiles and nine of sixteen IIEF-6 profiles met the respective exploratory threshold for possible dysfunction. No association or group comparison remained statistically significant after correction. Six of eighteen threshold-positive profiles had analyzable interviews, twelve represented narrative silence, and four interviewed participants were threshold-negative. Narratives documented fear, embarrassment, reduced desire or sexual frequency, relational or communication change, support needs, clinical sequelae, and positive or neutral adaptation. Screening and narratives showed convergence, complementarity, and divergence: low scores did not establish personal distress, whereas concerns could occur above a threshold. Conclusions: Responsive sexual rehabilitation should combine confidential, permission-based, patient-led screening and narrative inquiry with individualized information, optional support, appropriate referral, and reassessment according to readiness. These preliminary, hypothesis-generating findings do not validate an intervention or support confirmatory inference.

Nursing Reports doi: 10.3390/nursrep16070242

Authors: Keirran Hiscock Rebecca Miriam Jedwab

Background: Bronchiectasis is a chronic respiratory condition characterised by irreversible airway dilation and recurrent infections, resulting in significant symptom burden and frequent healthcare utilisation. Although nurses are central to chronic respiratory disease management, their specific roles and responsibilities in outpatient bronchiectasis care remain poorly defined. Understanding these roles is imperative to support workforce planning, optimise multi-disciplinary collaboration, and improve patient outcomes. Aim: This scoping review aimed to map and synthesise existing evidence on the roles and responsibilities of nurses involved in the outpatient management of adults with non-cystic fibrosis bronchiectasis. Methods: A scoping review was conducted. Six databases were systematically searched (MEDLINE, CINAHL Complete, Central, Web of Science, and ProQuest Dissertations and Theses Citation Index). Records describing nursing roles, responsibilities, or models of care within outpatient bronchiectasis settings were included (any design). Data was analysed descriptively and thematically. Results: Five studies and two international clinical practice guidelines published between 2002 and 2025 were included. Nurses were shown to play roles across five key domains: 1. clinical assessment and monitoring, 2. self-management support and patient education, 3. care co-ordination and multi-disciplinary collaboration, 4. patient advocacy and communication, and 5. leadership and service development. Evidence on measurable outcomes and standardised role definitions remains limited. Conclusions: This review mapped five domains within which nurses may contribute to outpatient bronchiectasis care; however, most identified roles and responsibilities were derived from multi-disciplinary recommendations rather than explicit descriptions of nursing practice. Further research is required to better define nursing roles and responsibilities and evaluate nurse-led models of care in bronchiectasis outpatient care settings.

Nursing Reports doi: 10.3390/nursrep16070241

Authors: Rina Shoki Anna Kono Edward Barroga Yasuko Nagamatsu

Background/Objectives: The employment of migrant nurses requires structured support from local nursing staff. However, multiple challenges persist in facilitating effective collaboration. We aimed to clarify the efforts made by Japanese nurses and identify their support needs when working alongside migrant nurses in Japan. Methods: We adopted a qualitative descriptive design. Eighteen Japanese nurses with experience working alongside migrant nurses were recruited through hospitals employing migrant nurses. Semistructured interviews were conducted, and data were analyzed using qualitative descriptive analysis. We classified the codes derived from the participants’ narratives and inductively generated categories. Results: Japanese nurses’ efforts in working alongside migrant nurses were classified into five categories: “Overcoming language barriers,” “Respecting the nursing practices and cultural backgrounds of migrant nurses,” “Encouraging migrant nurses to gain self-confidence,” “Engaging Japanese staff in establishing support systems for migrant nurses,” and “Addressing the personal challenges faced by migrant nurses working abroad.” Three categories of support needs were identified: “Learning about nursing practices and cultural backgrounds of migrant nurses,” “Information exchange on how to support migrant nurses,” and “Support systems for enhancing migrant nurses’ competencies in Japan.” Conclusions: Japanese nurses demonstrated active efforts to address differences in language, culture, and nursing practices, while collaboratively establishing support systems involving other staff members. They also extended support to aspects of migrant nurses’ personal lives. However, additional institutional and external support is required. Structured opportunities should be developed to enhance their understanding of migrant nurses’ backgrounds, alongside continuing education initiatives to support migrant nurses’ integration into the Japanese healthcare system.

Nursing Reports doi: 10.3390/nursrep16070240

Authors: Hanan Alfaifi Michael Brown Clare McVeigh Lynne Marsh

Background: Moral distress is a significant concern in nursing, particularly among newly graduated registered nurses transitioning into professional practice. Limited experience, high workloads, and exposure to ethically challenging situations may negatively affect well-being and contribute to early-career attrition. Evidence on how NGRNs experience and manage moral distress globally and in Saudi Arabia remains limited, and the role of healthcare organisational factors in shaping this phenomenon is not yet well understood. Aim: This study aims to examine the experiences of NGRNs regarding moral distress in adult tertiary care hospitals in Saudi Arabia, focusing on contributing factors, coping strategies, and organisational influences. Methods: A mixed-methods sequential explanatory design will be used. In the quantitative phase, NGRNs will complete the Measure of Moral Distress—Healthcare Professionals (MMD-HP) and a demographic questionnaire. Data will be analysed using descriptive and inferential statistics to assess levels of moral distress and associations with intention to leave. The qualitative phase will involve semi-structured interviews with NGRNs and focus groups with nursing managers, which will be analysed using reflexive thematic analysis. Integration will occur at the data collection and interpretation stages. The study is guided by Bronfenbrenner’s Ecological Systems Theory. Ethical approval has been obtained from Queen’s University Belfast and the Najran Health Cluster. Expected Impact: The study is expected to provide a comprehensive understanding of moral distress among NGRNs and inform the development of targeted organisational strategies to support Registered Nurse wellbeing, retention, and quality of care.

Nursing Reports doi: 10.3390/nursrep16070239

Authors: Habib Alrashedi Nader Alnomasy Sudharani B. Banappagoudar Ebtsam Abou Hashish

Background/Objectives: This study aimed to assess technostress and burnout levels among healthcare practitioners, explore the relationships between technostress, perceived organizational support (POS), and burnout, and examine whether POS mediates this relationship using a suppression approach. The rapid proliferation of digital health technologies has increased technology-related job demands in healthcare settings. Technostress has become a major psychological risk factor associated with burnout, but evidence for its direct effects is inconsistent. Although organizational resources, especially perceived organizational support, might moderate this relationship, the underlying mechanism is not well understood, particularly in the context of rapidly digitalizing healthcare systems like Saudi Arabia’s. Methods: This was a cross-sectional, multicenter, descriptive-correlational study with a sample of 150 healthcare professionals conveniently selected from clinical settings in Saudi Arabia. Technostress Creators Scale, Copenhagen Burnout Inventory and Perceived Organizational Support Scale were used for data collection. Statistical analyses included Pearson correlations, multiple regression, bootstrap mediation analyses, and structural equation modeling. Results: Moderate levels of technostress were observed across all dimensions (M = 2.87–3.42). POS was positively related to technostress (r = +0.36, p < 0.001) and negatively related to burnout (r = −0.54, p < 0.001). The bivariate relationship between technostress and burnout was nonsignificant (r = −0.06, p = 0.437). Mediation analysis showed a significant negative indirect effect through POS (β = −0.19, p = 0.002) and a significant positive direct effect (β = +0.14, p = 0.019), indicating an inconsistent mediation (suppression effect). Structural equation modelling demonstrated excellent model fit consistent with a just-identified model. Conclusions: The findings suggest that the observed statistical associations are consistent with a suppression mediation model in which technostress was positively associated with burnout while also being associated with higher perceived organizational support, which in turn was negatively associated with burnout. POS plays a critical protective role but does not fully offset the harmful associations of technostress. Healthcare organizations should implement proactive support strategies, including continuous technical support, structured digital training, and active managerial engagement, to manage technostress and reduce burnout risk.