Search Results (2,537)

Maternal rejection is an uncommon postpartum behavioral disorder in mares that may compromise colostrum intake, mare–foal successful nursing acceptance, and neonatal survival. This retrospective observational study described the clinical presentation, therapeutic management, and short-term outcome of 27 mares diagnosed with maternal rejection between September 2023 and June 2026 in western Romania. Data regarding breed, parity, parturition, behavioral presentation, treatment, supportive management, time to maternal acceptance, and outcome were extracted from medical records. Associations between categorical variables were evaluated using Fisher’s exact test, while differences in time to acceptance were assessed using the Mann–Whitney U test. Primiparous mares represented 59.3% of cases, and obstetrical complications occurred in 48.1%. Aggressive behavior was the predominant presentation. Primiparous mares exhibited aggressive forms of rejection significantly more frequently than multiparous mares (p = 0.006) and required a significantly longer interval before maternal acceptance (median: 38 h versus 21 h; U = 117.0, p = 0.010). Oxytocin was the most frequently administered medication, and behavioral management accompanied pharmacological treatment in most cases. Maternal acceptance was achieved in 24 of 27 mares (88.9%). Early recognition and individualized multimodal management may contribute to favorable short-term outcomes. Full article

Rapid innovation-driven transitions have, across successive eras, been associated with increased psychological distress, substance use, and suicide when social and economic change outpaces the adaptive capacity of individuals, communities, institutions, and governments. The early artificial intelligence (AI) economy is emerging at an unprecedented pace, reshaping education, employment, and social organization in ways that may intensify these risks, particularly among young people. This perspective argues that school-based mental health nursing, working collaboratively with school psychologists, counsellors, physicians, and other interdisciplinary professionals, represents a practical upstream response to AI-era disruption. Drawing on historical evidence from the Industrial Revolution, population mental health research, and the contemporary mental health nursing literature, the paper examines the mechanisms through which rapid socio-economic change may contribute to psychological distress and substance-use problems. It further distinguishes AI as both a source of socio-economic disruption and a clinical tool that can support—but not replace—relationship-based nursing practice. Strengthening school-based mental health nursing within interdisciplinary systems offers a practical, prevention-oriented strategy to promote resilience, facilitate early intervention, and mitigate downstream mental health and substance-use harms during the AI transition. Full article

Background/Objectives: Despite its proven benefits, skin-to-skin contact (SSC) after caesarean section faces significant barriers to implementation. Complementing two previous randomised controlled trials conducted by our group, this descriptive qualitative study aimed to identify barriers and facilitators experienced by multidisciplinary healthcare teams, providing frontline insights into factors contributing to the inconsistent implementation of SSC. Methods: Following a phenomenological approach and the COREQ guidelines, 40 semi-structured interviews were conducted with healthcare professionals involved in caesarean care at a Spanish tertiary hospital, including anaesthetists, gynaecologists, neonatologists, midwives, nurses and nursing assistants. The data were thematically categorised at the semantic and pragmatic levels using MAXQDA software. Results: SSC implementation remains inconsistent in routine care. Despite the existence of an established institutional protocol, systematic adherence is hindered by high clinical workload, infrastructure constraints and inconsistent dissemination of guidelines. Professional barriers included gaps in training and entrenched routines, while attitudinal barriers stemmed from safety concerns following major abdominal surgery. Key facilitators included the absence of clinical complications and the positive emotional impact of SSC on family bonding. These findings provide critical diagnostic insights into implementation barriers, informing future strategies to enhance adherence to established institutional protocols. Conclusions: Although safe and feasible, post-caesarean SSC remains inconsistently implemented due to addressable barriers. Its routine adoption requires targeted multidisciplinary training, commitment from healthcare teams and infrastructural adaptations in post-anaesthesia care units (PACU). Full article

Background: Delirium management remains inconsistently implemented in intensive care units (ICUs), and existing studies provide limited insight into how assessment capability, organisational opportunity, and emotional motivation interact in Chinese tertiary care settings. Aim: To explore ICU nurses’ perceived barriers and facilitators to delirium assessment and management using the Capability, Opportunity and Motivation model of Behaviour (COM-B). Methods: A qualitative descriptive exploratory study was conducted with 14 registered ICU nurses from two tertiary hospitals in Chongqing, China, between December 2025 and February 2026. Purposive sampling captured variation in clinical experience, educational background, and ICU type. The first author conducted face-to-face interviews in Mandarin Chinese and completed the initial coding. COM-B informed both the interview guide and the deductive organisation of the analysis, while six themes and 33 lowest-level factors were developed within the three domains. During revision, the fixed analytic structure was audited against all 14 Mandarin transcripts, and the second author independently applied the fixed codebook to five complete transcripts selected for maximum variation; disagreements were resolved by returning to the original Mandarin context and predefined coding boundaries. Results: Eighteen barriers and fifteen facilitators were identified across six themes within the COM-B domains. Capability was strengthened by clinical experience, senior nurses’ intuitive pattern recognition, and conversational assessment, but constrained by difficulty recognising hypoactive delirium, uncertainty when assessing older adults, inconsistent use of CAM-ICU, and insufficient targeted training. Opportunity was enhanced by staffing, environmental control, peer support, family engagement, and physician collaboration, but restricted by fragmented visibility, sensory overstimulation, workload, restrictive visiting, and delayed medical responses. Motivation reflected the tension between professional duty and accountability for safety on one hand and emotional burden, verbal abuse, and violence on the other. Cross-domain accounts showed that opportunity constraints could amplify anxiety and safety-first motivation, narrowing feasible behaviour toward containment, whereas social support could sustain relational care. Conclusions: Delirium management was shaped by interacting behavioural, organisational, and emotional conditions. Strengthening assessment capability alone is unlikely to produce consistent practice without staffing, workflow, environmental, and interprofessional support. Mapping the findings to Behaviour Change Wheel intervention functions highlighted training, environmental restructuring, enablement, and modelling as priority candidate functions for prospective evaluation; education alone was unlikely to be sufficient. Reporting Method: This study was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research checklist. Patient or Public Contribution: No patient or public contribution was involved in the design, conduct or reporting of this study. Participants were registered intensive care unit nurses. Full article

Background: Current evidence on diabetes care interventions is either fragmented or focused on specific interventions targeting healthcare professionals or patients. This study aims to categorize diabetes care interventions involving physicians or nurses and their impact on health outcomes for individuals with diabetes. Additionally, it aimed to determine the proportion of favorable findings across healthcare intervention categories. Methods: This scoping review was conducted in primary care settings and guided by a health system framework. We searched articles from inception to June 2022 in databases including CENTRAL, MEDLINE, Embase, PsycINFO, and CINAHL. The classification of healthcare interventions was guided by the Cochrane Effective Practice and Organization of Care taxonomy and health system framework. Results: Results were reported following the PRISMA Extension for Scoping Reviews. From the initial pool of 13,406 articles, 116 met the eligibility criteria and reported interventions conducted across 119 countries or regions, of which 94 were high-level economies. Five healthcare intervention categories were identified: transforming the workforce; service content; re-designing the service delivery system; information and communication technology; and multifaceted. Patient health outcomes were classified into 3 overarching categories with 11 subcategories: clinical outcomes, behavioral outcomes, and psychosocial outcomes. The proportion of statistically significant favorable findings differed across intervention categories and outcome domains. Multifaceted interventions showed relatively higher proportions of favorable findings for clinical outcomes, whereas re-designing the service delivery system interventions showed relatively higher proportions for behavioral outcomes. ICT interventions frequently reported favorable findings related to blood glucose indicators. Conclusions: This study provides a comprehensive overview of healthcare interventions and health outcomes for diabetes in primary care settings. It emphasizes the importance of tailored interventions, delivery methods, and technology integration for effective diabetes management, advocating for a comprehensive approach from individual to societal levels. Full article

Background: Several strategies have been proposed to promote hydration among institutionalized older adults, including systematic hydration rounds and, more recently, the use of Socially Assistive Robots (SAR). However, their implementation in nursing homes remains limited. Objective: To compare changes in fluid intake over a one-month period among residents exposed to two hydration-promotion strategies and to identify baseline characteristics associated with fluid intake. Methods: A quasi-experimental study was conducted in a nursing home. Residents were assigned to either a systematic hydration rounds intervention with manual recording or a SAR-supported multicomponent educational intervention including reminders, positive reinforcement, and digital intake monitoring. Fluid intake was monitored for one month and analyzed using adjusted mixed-effects linear regression models. Results: Residents in the systematic hydration rounds group showed higher fluid intake throughout follow-up. In the longitudinal analysis, assignment to the SAR-supported group was independently associated with lower fluid intake during follow-up (β = −354.24 mL/day; p < 0.001), after adjustment for baseline fluid intake and functional dependence. No significant differences were observed in intake trajectories between strategies. Dysphagia was independently associated with lower fluid intake, whereas diabetes was associated with higher fluid intake. Conclusions: Residents assigned to the systematic hydration rounds group showed higher fluid intake during follow-up. Dysphagia was associated with lower fluid intake, highlighting the need to adapt hydration-promotion strategies to residents’ swallowing-related needs. Although the SAR-supported intervention was not associated with higher fluid intake, the findings suggest that technological tools for hydration promotion and monitoring require adequate integration into routine clinical practice. Full article

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. Full article

Introduction: Intensive care units are characterized by a high level of clinical and psychosocial demands. Previous research indicates that the work environment plays a significant role in shaping nurses’ occupational well-being; however, analyses that simultaneously consider organizational factors, perceived occupational exposure, and job satisfaction are still limited, particularly in the context of Central and Eastern European countries. Objectives: The aim of the study was to assess the relationships between psychosocial and organizational factors in the work environment and the level of perceived occupational exposure as well as job satisfaction among nursing staff working in intensive care units. Methods: The study was cross-sectional in design and was conducted in Poland among 226 nurses employed in intensive care units. Data were collected using an anonymous online survey that included an author-designed questionnaire and the standardized “Working Conditions” instrument developed by the Central Institute for Labor Protection—National Research Institute. Data analysis was performed using descriptive statistics, chi-square (χ²) tests, and binary logistic regression. The study was conducted and reported in accordance with the STROBE guidelines (Strengthening the Reporting of Observational Studies in Epidemiology). Results: A high psychosocial burden was observed in 49.6% of the participants, while a high organizational risk was found in 69.9%. Higher organizational risk was associated with a more than threefold increase in the odds of high perceived occupational exposure (OR = 3.47; 95% CI: 1.54–7.81). Conclusions: Psychosocial and organizational factors in the work environment play an important role in shaping perceived occupational exposure and job satisfaction among intensive care nursing staff. The results highlight the importance of organizational interventions, such as ensuring adequate nurse staffing, strengthening supportive leadership, and developing psychosocial support programs for staff. Full article

Empathy is essential to humanized nursing care, yet its relationship with emotional competence before professional entry remains insufficiently specified. This single-school cross-sectional study examined whether distinct dimensions of emotional competence were differentially associated with emotional empathy among 337 secondary-level vocational nursing students enrolled in a five-year Croatian program for general care nurses/medical technicians. Students completed the Emotional Skills and Competence Questionnaire (ESCQ-45) and the Emotional Empathy Scale from the E-Questionnaire, which primarily captures affective responsiveness to others’ distress and other negative-valence states. Spearman correlations, Kruskal–Wallis tests with Dunn–Holm post hoc comparisons, Welch tests, and hierarchical linear regression with heteroscedasticity-consistent type 3 robust standard errors were used. Emotional empathy correlated with emotion perception and understanding (ρ = 0.35, p < 0.001) and emotion management (ρ = 0.28, p < 0.001), but not with emotion expression and naming (ρ = 0.10, p = 0.070). In the fully adjusted regression model, emotion perception and understanding (β = 0.254, p < 0.001), emotion management (β = 0.254, p = 0.003), and female versus male reported sex (β = 0.277, p < 0.001) were statistically significant predictors, whereas clinical exposure was not (p = 0.429). Emotion expression and naming had a negative adjusted coefficient (β = −0.158, p = 0.040) after simultaneous control for the remaining predictors. The findings support a dimensional interpretation of emotional competence and indicate that negative-valence emotional empathy is more closely associated with recognizing, understanding, and managing emotions than with expressive emotional skills considered in isolation. Full article

Background: Assisted living houses an older, frailer and more heavily medicated population than ever, yet is often regulated as a social and not a clinical setting with no on-site nursing requirement. Polypharmacy accumulates where medication oversight is thinnest. Objective: To map the extent, nature and distribution of research on medication safety in assisted living in the narrow sense, and where the evidence clusters and thins. Methods: In this scoping review, PubMed and Web of Science were searched (26 May 2026; window 2010–2025) and records screened against a strict two-gate rule: assisted living in the narrow sense, explicitly labelled and central, plus a central medication-safety or coordination concept. Residential-care and long-term-care populations fell outside it. Titles, abstracts and full texts were screened and charted thematically. Results: Twenty-two sources met the strict definition, drawn from four countries: the United States (13), Finland (6), Canada (2) and the United Kingdom (1). Five themes emerged, covering burden (4), safety (4), interventions (4), antimicrobial stewardship (4) and coordination and regulation (6). A further 11 comparison-context reports were kept separately. Every randomised trial was Finnish and came from one research programme. Conclusions: Assisted living has become a high-acuity medication environment without matching oversight. The setting-specific literature is real but sparse, and rigorous deprescribing and coordination trials remain scarce. The binding constraint is structural rather than pharmacological, a missing point of clinical accountability that is patterned by regulation, so closing the gap is as much a public-health task as a clinical one. Full article

Background/Objectives: Internet Gaming Disorder (IGD) is included in ICD-11 and poses a substantial risk to Saudi university students, yet no structured nursing intervention framework exists within Saudi higher education health services. This paper presents the Resilience-Based Nursing Intervention Framework (RBNIF), a three-tiered, theory-driven nursing architecture translating evidence on impulsivity, resilience, and IGD into practice specifications for this setting. Methods: Using secondary analysis of a dataset of 207 gaming students from four King Saud University colleges, framework development followed a four-phase Medical Research Council (MRC) process: theoretical identification (I-PACE, Dual Process Theory, COM-B), evidence synthesis, Behavior Change Wheel/Intervention Mapping, and cultural adaptation via Bernal et al.’s Ecological Validity Framework. Results: The sample (58.9% male; 20–25 years, 61.4%; bachelor’s level, 73.9%) yielded three tiers differentiated by a dual-domain screening rule (elevated impulsivity and/or low resilience, rather than a single combined score): Tier 1 (universal psychoeducation); Tier 2 (six-session group program, S-UPPS-P ≥ 52 and/or CD-RISC-10 ≤ 20; 63 of 207 participants [30.4%]); and Tier 3 (10-session RIRDH clinical program, IGDS9-SF ≥ 36, met by 38 of 207 participants [18.4%]). Fifty-two participants (25.1%) met the elevated-impulsivity criterion, and 51 (24.6%) met the low-resilience criterion. Each tier specifies nursing competencies and behavior change techniques, with cultural adaptation integrating Islamic values concepts (sabr, mizan, tawakkul), family protocols, and single-sex delivery. Conclusions: To our knowledge, the RBNIF is the first theory-driven, culturally adapted nursing intervention architecture for IGD in Saudi university health services; a focused, non-systematic search of PubMed, Scopus, and CINAHL identified no directly comparable published framework. It is pre-implementation and requires feasibility testing, pilot evaluation, and a cluster-randomized controlled trial (c-RCT). Full article

Background: Hospital-wide centralized bed allocation, known in China as the “one-bed-for-the-whole-hospital” model, aims to improve inpatient access by pooling beds across specialties. Existing studies have mainly examined operational outcomes, process risks, or staff competence. Less is known about how bed redistribution interacts with clinical responsibility, professional roles, functional support, and shared governance. Objectives: This study explored healthcare professionals’ perspectives on the barriers, facilitators, and strategies for sustaining the hospital-wide “One Bed” model. It also examined how bed integration and care integration aligned or diverged across the dimensions of the Rainbow Model of Integrated Care. Methods: A single-center descriptive qualitative study was conducted in a Grade A tertiary hospital in Shanghai, China, where the model had operated across 11 pilot wards for approximately 48 months. Between December 2024 and March 2025, 25 healthcare professionals, including 14 clinical nurses, eight head nurses, and three physicians, completed face-to-face semi-structured interviews. Data were analyzed using inductive qualitative content analysis. After themes and subthemes were developed from participants’ accounts, the Rainbow Model of Integrated Care was used as an interpretive framework to map the findings across clinical, professional, organizational, system, functional, and normative integration. Results: Five themes were generated. Participants perceived centralized bed allocation as shortening waiting time and improving bed use, but also as intensifying ward workload and making single efficiency indicators insufficient. Patients could move to available wards before medical response, responsibility, and physician visibility were fully aligned. Cross-specialty case mixes exceeded what nurses could manage through temporary learning alone. Information, logistics, space, equipment, and supplies did not always move with patients, leaving nurses to maintain workflow through manual and often invisible coordination. Sustained bed sharing also depended on clearer boundaries for patient selection, specialty fit, severity, nursing workload, leadership authority, resources, and incentives. Together, these themes showed that bed resources were integrated faster than care processes, professional capability, functional support, and shared governance. Conclusions: Hospital-wide centralized bed allocation should be understood as an uneven process of integration rather than only as a bed-management strategy. These findings primarily reflect the perceptions and experiences of nurses and nursing managers, supplemented by limited physician input. The distinctive finding of this study is that beds may be pooled, and patients may move rapidly, while medical response, nursing competence, functional support, workload recognition, and governance arrangements do not always move at the same pace. Safe and sustainable implementation therefore requires bounded flexibility: bed allocation should be guided not only by bed vacancy but also by clinical suitability, specialty fit, nursing workload, timely medical response, functional systems that move with patients, and shared accountability. Full article

Background: Chronic lower limb wounds, such as diabetic and vascular ulcers, affect up to 2% of the global population, imposing high healthcare costs and a significant risk of amputation. Although nursing care and traditional treatments are fundamental, single-use portable Negative Pressure Wound Therapy PICO 7 system, has emerged as a cost-effective alternative. The objective of this study was to evaluate the effectiveness of PICO 7, compared to the usual treatment in chronic lower limb wounds or their dehiscence in amputations. Methodology: A randomized, controlled, open-label clinical trial was conducted at the Hospital Universitario de Toledo (2024–2026). The final analyzed sample consisted of 31 patients (Intervention Group, IG: 14; Control Group, CG: 17). Both groups followed the dynamic TIME strategy to standardize wound bed preparation. Primary variables included healing rate, healing time, wound area reduction, clinical safety (infections and adverse effects), pain levels, health-related quality of life, and physical activity. Statistical analysis was performed using SPSS v.28. Results: The IG showed a higher mean percentage reduction in wound size, although the between-group difference did not reach statistical significance. No infections were recorded in the IG. Regarding quality of life and physical activity, the CG showed a significant post-intervention decline, whereas the IG remained stable. A significant negative correlation was found between final wound size and hours of sleep, suggesting that wound reduction facilitates better rest. Conclusions: The PICO 7 system appears to be a safe and feasible alternative to conventional wound care. Favorable trends in wound area reduction should be interpreted cautiously given the lack of statistically significant between-group differences. Full article

Background/Objectives: Eating disorders (EDs) have historically been associated with young women, and their presence in older adults remains poorly recognized despite evidence that they can persist, recur, or emerge in later life. Primary care nurses are strategically positioned for community-based detection, yet their perspective has been scarcely explored. This study aimed to examine the experiences, perceptions, and described practices of primary care nurses regarding EDs and disordered eating in older adults, identifying patterns, barriers to detection, and training needs. Methods: A qualitative study with a descriptive design was conducted in three Primary Health Care Centers from different health areas of Spain. Thirty-two registered practicing nurses participated in three focus groups, guided by a clinical vignette and a semi-structured interview guide. Data were analyzed following Braun and Clarke’s reflexive thematic analysis, supported by ATLAS.ti software (version 24.2, 2024). Results: EDs in older adults frequently remained invisible to professionals, sustained by three interrelated mechanisms: the cultural hegemony of the biomedical paradigm, which reframes symptoms as organic or cognitive; a selective historicization that attributes altered eating to the postwar “hunger years”; and an “ageism of care” that normalizes warning signs as expected features of aging. Notably, when the diagnostic possibility was explicitly named, participants retrospectively reinterpreted cases they had previously explained in other terms. Conclusions: This invisibility stems not from an absence of clinical signs, but from professional, cultural, and institutional interpretive frameworks. Findings underscore the need for specific training, adapted screening tools, and a critical perspective on ageism in nursing practice. Full article

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. Full article