Search Results (2,136)

Background: Healthcare professionals in Singapore’s primary care face sustained workload pressures and increasing complexity. Grounded in the Job Demands–Resources model, this study identifies demographic, clinical, and lifestyle factors associated with psychological distress among staff across two independent windows spanning the pre- and post-pandemic periods. Methods: The study was conducted among staff in National University Polyclinics (NUP) Singapore. De-identified health screening data included demographics, occupation, clinical measures, medical history, and lifestyle behaviours. Primary outcome was psychological distress, assessed across 2 distinct observation windows: the Hospital Anxiety and Depression Scale (HADS) from 2018–2022 (abnormal ≥ 8) and the General Health Questionnaire-12 (GHQ-12) from 2023–2025 (abnormal ≥ 2). Multivariate mixed-effects logistic regression identified factors associated with psychological distress while accounting for within-person clustering. Results: We analysed 3307 screening visits from 1260 staff. Within the HADS observation window (2018–2022), abnormal scores were significantly higher in 2022 compared with 2018 (OR 2.28, 95% CI 1.64–3.17). Within the GHQ-12 observation window (2023–2025), a non-significant decline in abnormal scores was observed. Older age (2018–2022: OR 0.967, 95% CI 0.948–0.987; 2023–2025: OR 0.955, 95% CI 0.928–0.983) and regular exercise (2018–2022: OR 0.724, 95% CI 0.529–0.991; 2023–2025: OR 0.357, 95% CI 0.231–0.551) were consistently associated with lower odds of distress. Medical staff had significantly lower odds of distress compared to ancillary staff in 2018–2022 (OR 0.391, 95% CI 0.207–0.739). Regular alcohol use was associated with higher distress in 2018–2022 (OR 1.56, 95% CI 1.05–2.31), while active smoking (OR 5.79, 95% CI 1.75–19.10) and family history of chronic disease (OR 2.22, 95% CI 1.28–3.87) were significant in 2023–2025. Conclusions: Older age and regular exercise were consistently associated with lower odds of psychological distress across both windows, while ancillary staff and alcohol use (HADS window), and smoking and family history of chronic disease (GHQ-12 window) were period-specific determinants. These findings support the implementation of proactive, targeted wellness initiatives alongside the routine mental health surveillance among primary care staff. Full article

Background/Objectives: Early recognition of psychological distress is an important component of integrated healthcare, particularly among patients experiencing social and linguistic vulnerability. This hypothesis-generating study examined how observable expressions of distress were conveyed and addressed in multilingual hospital encounters. Methods: An exploratory qualitative analysis was conducted using fifteen interpreter-mediated consultations purposively selected from the Intercomsalud corpus because verified transcripts were available. The sample included consultations in Arabic (n = 6), Chinese (n = 2), English (n = 5), Russian (n = 1) and Ukrainian (n = 1). Coding distinguished (1) explicit verbal distress, (2) observable emotional cues, and (3) researcher-inferred distress; it also described full, partial or non-relay and the healthcare professional’s observable response within the recording. Results: In the analysed consultations, biomedical and procedural information was generally conveyed in recognisable form. Some explicit distress expressions and observable cues were reduced, reformulated or not explored, whereas other encounters showed sustained acknowledgement. The psychology consultation provided a suggestive, uncontrolled contrast and cannot establish a department effect. Conclusions: The cases illustrate that clinical-content relay and affective recognition can be examined as related dimensions, but the present sample primarily documents accurate clinical-content relay with variable affective recognition and does not empirically validate their full independence. Larger, independently coded studies with follow-up data are needed. Full article

Background: Health-related quality of life (HRQoL) and job satisfaction are important indicators of nurses and physicians’ wellbeing and system sustainability, particularly under conditions of high clinical demand. Although organizational determinants of nurses and physicians’ wellbeing have received increasing attention, evidence regarding protocol-based work as a specific organizational characteristic remains limited. Methods: A multicenter cross-sectional study was conducted in 11 Greek public hospitals between September 2022 and March 2023. The study included 405 nurses and physicians (214 nurses and 191 physicians). HRQoL was assessed with the SF-36 and job satisfaction with the MSQ-Short Form. Protocol-based work was assessed using a single self-reported dichotomous item referring to the use of standardized clinical protocols during the pandemic. Associations between workplace characteristics and outcomes were examined using multivariable linear regression models. Results: Vitality (57.24 ± 17.61 among nurses and 53.92 ± 16.93 among physicians) and general health (56.58 ± 19.81 and 53.42 ± 16.32, respectively) were the lowest-scoring HRQoL dimensions in both professional groups. Compared with physicians, nurses reported higher mental health (62.52 vs. 58.11, p < 0.05), social functioning (67.17 vs. 58.96, p < 0.05), and overall job satisfaction (3.23 vs. 2.98, p < 0.01), whereas physicians scored higher in physical functioning (83.47, p < 0.05) and bodily pain (72.87, p < 0.05). Conclusions: Several organizational characteristics were associated with wellbeing among nurses and physicians. Protocol-based work showed consistent associations with better HRQoL and job satisfaction across multiple outcomes. However, longitudinal studies are needed to determine whether these associations reflect causal relationships. Full article

Background and Objectives: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and a major cause of stroke, heart failure, and death. Evidence on AF in Latin American and Andean tertiary-care settings remains limited. The objective was to describe the demographic and clinical profile, documented thromboembolic and bleeding risk, in-hospital management, and outcomes of adults with AF treated at a tertiary hospital located at 2850 m above sea level. Materials and Methods: We retrospectively reviewed unique adult patient records from January 2021 through December 2023 identified by ICD-10 code I48 and explicit clinician documentation of AF. Independent electrocardiographic adjudication was not performed. Demographics, comorbidities, chart-recorded AF category, risk scores, echocardiographic findings, in-hospital treatments, and outcomes were summarized descriptively. Results: Among 238 patients, mean age was 77.9 ± 13.3 years, 55.0% were male, and 97.1% were recorded as mestizo. Hypertension (58.0%) and heart failure (22.7%) were the most frequent comorbidities. CHA₂DS₂-VASc and HAS-BLED scores were documented for 199 patients (83.6%); their respective means were 3.3 ± 1.4 and 2.3 ± 1.1. Any anticoagulant was administered during hospitalization to 195 patients (81.9%), but previous and discharge therapy, indications, contraindications, dosing, and temporary interruptions were not consistently available. Five patients died in hospital (2.1%). Secondary exploratory comparisons by survival status were hypothesis-generating, and none remained significant after false-discovery-rate correction. Conclusions: This cohort describes an older, comorbid population treated at a hospital situated at high altitude. The study does not establish an altitude-related AF phenotype, the appropriateness of chronic anticoagulation, or prognostic factors for mortality. Prospective multicentre studies with adjudicated AF, individual altitude exposure, oxygenation and haematologic measures, and longitudinal treatment data are warranted. Full article

Background: G6PD deficiency is among the leading causes of neonatal hyperbilirubinemia and kernicterus. Following a 2022 New York State Department of Health recommendation to test high-risk neonates, we implemented universal G6PD deficiency screening in the well-baby nursery. Objectives: We aimed to increase the proportion of infants screened from 0% to more than 75% within 6 months and to describe the prevalence of G6PD deficiency and the early outcomes of affected neonates. Methods: This quality improvement (QI) initiative, guided by the Model for Improvement, included a cross-sectional analysis of screening yield and early neonatal outcomes. A statistical process control p-chart tracked monthly screening. Outcomes were compared between screen-positive and screen-negative infants using the Fisher exact test. Results: Screening rose from 0% to a sustained mean of 81.1%, exceeding the 75% aim. Of 580 screened neonates, 52 (9.0%) screened positive for G6PD deficiency. Screen-positive infants were more likely than screen-negative infants to undergo repeat serum bilirubin testing (38.5% vs. 19.3%; p = 0.002) and to reach a peak bilirubin above 10 mg/dL (30.8% vs. 10.2%; p < 0.001). A higher rate of readmission for phototherapy was also observed (5.8% vs. 0.9%; p = 0.028), though based on few events. Phototherapy during the birth hospitalization, IVIG, and exchange transfusion did not differ. Conclusions: Universal G6PD screening was feasibly implemented and sustained in a high-risk well-baby nursery through routine workflow changes, without additional phlebotomy. Nearly 1 in 11 screened neonates tested positive for G6PD deficiency. Full article

Background: Effective discharge education is essential for promoting postoperative recovery following transurethral resection of the prostate (TURP); however, conventional discharge education may be insufficient to adequately prepare patients for self-care after discharge. Virtual reality (VR)-assisted education has emerged as an innovative approach that provides immersive and interactive learning experiences. This study aimed to evaluate the effect of VR-assisted discharge education on readiness for hospital discharge in patients undergoing TURP. Methods: A randomized controlled trial was conducted with 68 patients undergoing TURP at a university hospital. Participants were randomly assigned to either an intervention group (n = 34), which received standardized VR-assisted discharge education before surgery in addition to routine care, or a control group (n = 34), which received routine discharge education alone. Readiness for hospital discharge was assessed using the Readiness for Hospital Discharge Scale–Short Form (RHDS-SF) before the intervention and immediately prior to discharge. Data were analyzed using a two-way mixed-design analysis of variance. Results: Mean baseline scores were comparable between groups. Readiness for hospital discharge increased significantly over time in both groups; however, the improvement was significantly greater in the intervention group. Mixed-design ANOVA demonstrated a significant main effect of time (p < 0.001) and a significant time × group interaction (p < 0.001), indicating that VR-assisted discharge education produced greater improvements in discharge readiness than routine discharge education. The RHDS-SF demonstrated acceptable to good internal consistency across the two measurement points (Cronbach’s α = 0.705 at pre-test and 0.807 at post-test). Conclusions: The structured VR-assisted discharge education intervention resulted in greater improvements in perceived readiness for hospital discharge than routine discharge education among patients undergoing TURP. Structured VR-assisted education may be a useful complementary approach to routine discharge education for supporting patients’ preparedness for postoperative self-care. Further multicenter studies with longer follow-up are needed to determine whether these improvements result in sustained clinical benefits. Full article

Background: Stroke is the third leading cause of death and a major cause of long-term disability in Malaysia, where the continuity of post-stroke care depends heavily on unpaid, untrained informal family caregivers. These caregivers face a well-documented “discharge cliff,” assuming complex medical and rehabilitative responsibilities with minimal preparation. The locally developed “CaknaStrok” mobile health (mHealth) application was designed to bridge this support gap. However, the existence of a tool does not guarantee its use; sustained adoption depends on whether caregivers find the application acceptable and are willing to integrate it into an already demanding caregiving routine. Objectives: This protocol describes a study designed to determine the levels of acceptability and willingness to use the CaknaStrok application, to examine the associated predictors (effort expectancy, ability, digital health literacy, and intervention coherence), and to test the central mediating role of acceptability through a novel Integrated Acceptability–Willingness (IAW) Framework. Methods: An explanatory sequential mixed-methods design will be conducted at the Stroke Ward of Hospital Canselor Tuanku Muhriz (HCTM), a World Stroke Organization-certified Advanced Stroke Centre. In Phase I, a target of 200 informal primary caregivers will be recruited through consecutive sampling and surveyed using a validated, bilingual (Malay/English) self-administered questionnaire that operationalises the IAW constructs through three established instruments (UTAUT, the Digital Health Literacy Instrument, and the Theoretical Framework of Acceptability). Following a standardised facilitated onboarding, caregivers use the application ad libitum for four to six weeks before completing the questionnaire. Expected Results: The study will quantify caregiver acceptability and willingness to use, identify which factors most strongly drive acceptance, and empirically test whether acceptability mediates the relationship between the predictors and willingness to use. Qualitative themes will contextualise the statistical pathways, surfacing culturally specific mechanisms of adoption that single-method designs typically miss. Ethical approval was obtained from the UKM Research Ethics Committee (JEP-2024-392). Conclusions: This study is expected to generate context-sensitive evidence to guide the design of caregiver-facing mHealth interventions and inform future multi-site implementation and policy development efforts within the Malaysian stroke-care pathway. Full article

Background: Each year, hundreds of thousands of geriatric patients suffer proximal femur fractures, which often result in irreversible functional decline. Although anti-osteoporotic medications have been shown to reduce the incidence of fragility fractures, the effects of pharmacotherapy on fracture injury patterns, postoperative ambulatory capacity, and survival outcomes are not yet fully understood. Methods: We conducted a retrospective cohort study using the AltersTraumaRegister DGU ^® (ATR-DGU), a multicenter prospective registry spanning 196 certified geriatric trauma centers in Germany, Austria, and Switzerland (2016 through 2024). We included patients aged 70 years or older with isolated, surgically treated proximal femur fractures and stratified them by documented use of osteoporosis medication before the index fracture (OM group) versus no pre-fracture therapy (no-OM group). Primary endpoints were mortality during the acute hospital stay and at 120-day follow-up, as well as walking ability—defined as any functional ambulation versus none—at 7 and 120 days postoperatively. The main secondary endpoint was fracture morphology. We fitted multivariable logistic and linear regression models adjusted for age, sex, ASA classification, and anticoagulation; walking-ability models were additionally adjusted for pre-fracture ambulatory status. Results: Of 70,386 patients (mean age, 84.4 years; 70.4% female), 15,771 (22.4%) were receiving osteoporosis medication prior to the index fracture. Patients in the OM group were frailer with worse ASA Scores (80.3% vs. 72.5% with an ASA ≥3) and lower ambulation (62.5% vs. 50.4% requiring at least two crutches or not able to ambulate out of the home environment). Patients in the OM group had a 19% higher chance of sustaining a trochanteric versus a femoral neck fracture than patients in the no-OM group (51.9% vs. 46.8%; adjusted odds ratio 1.19; 95% CI, 1.15 to 1.24; p < 0.001). Pre-existing therapy showed no association with mortality during the acute hospital stay (adjusted OR, 0.93; 95% CI, 0.86 to 1.01; p = 0.098) or with walking ability at 7 days (adjusted OR, 1.03; 95% CI, 0.98 to 1.09; p = 0.198). At the 120-day follow-up (n = 19,544 in the adjusted model follow-up cohort), slightly higher odds of death were observed in the frailer OM group (adjusted OR, 1.12; 95% CI, 1.01 to 1.25; p = 0.04), though the lower confidence bound approached unity. A trend toward improved ambulation was seen in the OM group at 120-day follow-up (adjusted OR, 1.11; 95% CI, 0.99 to 1.25; p = 0.074). Conclusions: Pre-existing osteoporosis therapy was associated with lower odds of femoral neck versus trochanteric fracture patterns. A trend toward improved ambulation accompanied a slightly increased risk of mortality in patients with pre-existing osteoporosis therapy at 120-day follow-up, although this must be weighed against substantial loss to follow-up and residual confounding. More research is needed to understand the effects of anti-osteoporosis medications on patients who do suffer hip fractures despite osteoporotic therapy. Full article

Introduction: Early debridement of burn eschar is a cornerstone of care for patients with extensive burns, yet early large-area surgical excision may be limited by blood loss, physiological instability, and substantial logistical demands. Evidence on bromelain-based enzymatic debridement involving treatment areas greater than 15% total body surface area (TBSA) remains scarce. Case Report: A 38-year-old man sustained partial- and full-thickness burns involving 97% TBSA, together with inhalation injury. Sequential enzymatic debridement with NexoBrid was performed at the bedside in five 4-h sessions under intensive care conditions, with 14–27% TBSA treated per session. Complete eschar removal was achieved within 64 h of admission without transfer to the operating room, major procedure-related bleeding, or transfusion during the debridement period. The subsequent course was complicated by sepsis and severe respiratory failure requiring veno-venous extracorporeal membrane oxygenation. Following intensive care treatment, the patient stabilized markedly, ECMO support was discontinued, and near-complete wound coverage was achieved. He died on hospital day 87 following acute intrapulmonary and endotracheal hemorrhage of unclear etiology. Conclusions: This case illustrates the technical feasibility of early, sequential bedside enzymatic debridement in a near-total burn and may inform its carefully selected off-label use in highly specialized burn centers. Full article

Background: The emergence of multidrug-resistant (MDR) uropathogenic Escherichia coli (UPEC) poses a significant public health challenge, and alternative treatments are urgently needed. Methods: Here, we identified clinical MDR-UPEC strains AT82 and AT84 collected from hospitalized patients that display extensive antimicrobial resistance at both genetic and phenotypic levels. Due to their high resistance profile, we systematically customized a phage cocktail from our coliphage library using hierarchical clustering based on host specificity and candidate selection through bacterial suppression profiles. Results: This pipeline yielded four lytic coliphages, designated Phi25-4, Phi25-6, Phi50-4, and Killian. Their genomes are relatively large ranging from 112–169 kbp and cluster into two distinct lineages comprising two closely related groups: Phi25-4/Phi50-4 and Phi25-6/Killian. Although each phage exhibited potent antibacterial activity, none alone sustained bacterial suppression during prolonged treatment. To overcome this limitation, we systematically compared the antibacterial activity of all possible phage combinations. Conclusions: The four-phage cocktail outperformed all two- or three-phage formulations, sustaining significant growth inhibition of AT82 and AT84 for up to 16 h and reducing area under the curve by more than 80% relative to controls. Cocktail potency was dose-dependent, with lower phage doses yielding the least viable cells at 48 h. Additionally, this cocktail exerted prophylactic action, significantly reducing UPEC invasion by several orders of magnitude, while the phage cocktail alone induced minimal proinflammatory cytokine responses in human bladder epithelium. Together, these findings provide an effective phage cocktail and a complementary framework for cocktail design against urinary tract infections caused by MDR bacteria. Full article

This study examines the direct and indirect associations of green leadership with green performance and organizational sustainability through green work climate and green innovative behavior. Drawing on Social Information Processing Theory, it specifies a bounded associational framework that differentiates leadership-related environmental cues, employee-perceived workplace context, self-reported behavioral action, and employee-assessed organization-referent outcomes. Data were collected from 798 employees working in five-star hotels and licensed travel agencies in Saudi Arabia and analyzed using partial least squares structural equation modeling (PLS-SEM). The findings reveal positive associations among all focal constructs. Green leadership is most strongly associated with green work climate, while green innovative behavior is more closely associated with green performance than with organizational sustainability. All hypothesized specific and theoretically ordered serial indirect coefficients are statistically significant, including the extended association linking green leadership with organizational sustainability through green work climate, green innovative behavior, and green performance. By jointly estimating direct, specific indirect, and serial indirect associations, the study differentiates the perceptual and behavioral functions of green work climate and green innovative behavior and distinguishes green performance from broader organizational sustainability. From a sustainable development perspective, the findings identify employee-assessed organizational conditions associated with resource efficiency, waste reduction, environmentally oriented innovation, continuing environmental and social responsibility, local economic participation, and community well-being. These areas are relevant particularly to Sustainable Development Goals 8, 9, 12, and 13. However, because sustainable development was not directly measured, these implications concern the potential contribution of organizational practices to sustainable development rather than verified destination- or societal-level development outcomes. Full article

Human Digital Twins (HDTs) extend traditional Digital Twin (DT) concepts by modeling both humans and hospital processes to support smarter and more human-centered healthcare. By integrating Industry 4.0 (I4.0) technologies with the human-centric principles of Industry 5.0 (I5.0), HDTs offer new opportunities to improve hospital operations. This study presents a PRISMA-based systematic literature review to examine the role of HDTs in hospital operations. A total of 329 papers were identified through the initial search, and after the screening process, 22 studies were included for in-depth analysis. The review combines bibliometric analysis to examine publication trends, leading authors, contributing countries, and keyword co-occurrence with a content analysis to identify the main research themes. Three major themes emerged: (1) HDT architectures and data integration, (2) human-centric and governance aspects, including explainable artificial intelligence and privacy, and (3) operational and clinical outcomes, including patient flow, resource utilization, and staff support. Based on these findings, the study proposes a four-layer HDT framework for practical implementation in hospital operations. Although the reviewed studies indicate that HDTs have considerable potential to improve operational efficiency and strengthen human involvement, most existing research remains conceptual or simulation-based. Future research should therefore prioritize real-world implementation and validation while incorporating ethical, explainable, and sustainable design principles. Full article

Background/Objectives: Sustainable Human Resource Management in healthcare requires the identification of factors that support motivation, well-being, and employment sustainability in nursing staff. The aim of this study was to assess motivating and demotivating factors related to nurses’ work motivation in a Polish university clinical hospital and to examine their associations with selected sociodemographic and occupational characteristics in order to identify Sustainable HRM practices that may be relevant to staff retention, professional resilience, and long-term workforce sustainability. Methods: The study was conducted among 300 nurses using a diagnostic survey method between October 2023 and March 2024. Associations between variables were examined using the χ² test of independence and Cramér’s V. Results: Salary level was the most important financial motivating factor in the nurses’ opinions. With regard to non-wage factors, the opportunity to improve qualifications at the employer’s expense was predominant. Friendly team relationships were identified as the key non-material motivating factor. The most frequently indicated demotivators were low salary, low occupational status, poor relationships with supervisors or team members, and limited autonomy. Significant associations were observed between financial motivating factors and age, professional experience, employment type, and salary level. Associations for indirect material, non-material, and demotivating factors were less consistent and generally weak. Conclusions: Effective nursing workforce management should combine fair remuneration with opportunities for professional development and measures that support positive workplace relationships and organizational culture. Interpreted within the Sustainable HRM framework, these findings may inform practices intended to support staff retention, professional resilience, and long-term workforce sustainability. Full article

Background/Objectives: Antimicrobial resistance threatens public health globally, and critical access hospitals (CAHs) serving rural communities face structural barriers to implementing antibiotic stewardship programs (ASPs). This study evaluated whether a regional educational intervention could improve antimicrobial stewardship knowledge and implementation among rural healthcare professionals. Methods: A quantitative, quasi-experimental repeated cross-sectional evaluation was conducted following Antibiotic Stewardship conferences in 2023 and 2024. Participants from 38 rural and critical access hospitals completed pre-conference, post-conference, 6-month follow-up, and implementation surveys. Quantitative data were analyzed using descriptive statistics and unpaired chi-square tests, with Fisher’s exact test substituted where expected cell counts were below 5, with significance set at p < 0.05. Results: Seventy healthcare professionals participated across both years. Correct identification of the use of an antibiogram to guide empiric (rather than definitive) therapy improved from 27% pre-conference to 58% post-conference (p = 0.029). Confidence in antibiogram interpretation increased from 67% to 100% post-intervention (p = 0.004, Fisher’s exact) but declined to 50% (5 of 10) at 6-month follow-up. Knowledge of the minimum isolate threshold required to construct an antibiogram improved from 23% (7 of 30) pre-conference to 64% (7 of 11) at 6-month follow-up (p = 0.026, Fisher’s exact). Despite this, prescribing intent for conditions where antibiotics are typically unnecessary showed minimal improvement: recommendations for antibiotic use in middle ear infections decreased from 50% to 36.84%, and for mpox from 20% to 15.79%. All participants reported intent to modify clinical practice; however, time constraints, technology limitations, and lack of resources were consistently cited as primary barriers for implementation across both survey years. Conclusions: A regional educational intervention improved short-term antimicrobial stewardship knowledge and confidence among rural healthcare professionals, but knowledge retention declined over time and structural barriers persisted. Education alone is insufficient; sustained reinforcement and rural-adapted ASP models incorporating protected ASP time, decision-support tools and external partnerships are needed to translate knowledge gains into consistent stewardship practice. Full article

Workplace romance presents a paradoxical challenge for organizations, capable of enhancing employee engagement while simultaneously triggering destructive interpersonal dynamics. This study probes the darker contours of this phenomenon within Saudi Arabia’s rapidly expanding hospitality and travel sectors—a context where Vision 2030’s ambitious tourism agenda renders workplace social processes especially consequential for organizational sustainability. While prior research has predominantly examined either the benefits of workplace romance or its isolated negative outcomes, limited empirical attention has been devoted to understanding how romance-induced social mechanisms jointly translate into counterproductive work behaviors (CWBs) and whether psychological resources can buffer these adverse effects. Integrating the Stimulus–Organism–Response framework with Conservation of Resources theory, this study develops and tests a model wherein workplace romance (WR) functions as a relational stimulus that elicits workplace ostracism (WO) and employee envy (EE), which subsequently foster CWBs, with organization-based self-esteem (OBSE) moderating the WR–WO and WR–EE linkages. Survey data from 434 employees across international hotels and travel agencies were analyzed using PLS-SEM, demonstrating robust measurement properties. The results reveal that higher levels of workplace romance are statistically associated with higher levels of workplace ostracism and employee envy, each of which shows a significant indirect association between workplace romance and counterproductive work behaviors. In the hypothesized order, workplace romance is associated with workplace ostracism and employee envy, and these variables jointly exhibit a serial indirect association with counterproductive work behaviors consistent with the proposed model, although this pattern should be interpreted as correlational rather than causal given the cross-sectional design. Furthermore, OBSE significantly attenuates the positive effects of WR on both WO and EE, underscoring its function as a protective psychological reservoir. While the cross-sectional, self-report design and single-country focus constitute notable limitations, they also underscore the imperative for multi-source, longitudinal investigations. Practically, these findings suggest that proactively managing workplace romance, mitigating ostracism and envy, and cultivating OBSE may support organizational efforts that are consistent with SDG 8 (Decent Work and Economic Growth), SDG 3 (Good Health and Well-Being), and SDG 10 (Reduced Inequalities) within Saudi Arabia’s tourism-led development trajectory, even though these goals were not directly measured in this study. Full article