Search Results (909)

Background: Moral harassment (mobbing) in healthcare, particularly among nurses, remains a persistent issue with detrimental effects on mental health, resilience, and quality of life. Aim: We examine the relationship between the resilience of nurses working in Emergency Departments (EDs) and how these factors influence experiences of workplace mobbing. Methods: This cross-sectional study included 90 nurses from four public hospitals in Greece’s 5th Health District. Data were collected between October 2023 and March 2024 using the WHOQOL-BREF, Workplace Psychologically Violent Behaviors (WPVB) scale and the Connor–Davidson Resilience Scale (CD-RISC). The sample consisted primarily of full-time nurses (84.3% female; mean age = 43.1 years), with 21.1% reporting chronic conditions. Most participants were married (80.0%) and had children (74.4%), typically two (56.1%). Statistical analyses—conducted using SPSS version 27.0—included descriptive statistics, Pearson and Spearman correlations, multiple linear regression, and mediation analysis, with significance set at p < 0.05. Results: Resilience was moderate (mean = 66.38%; Cronbach’s α = 0.93) and positively correlated with all WHOQOL-BREF domains—physical, psychological, social, and environmental (r = 0.30–0.40)—but not with the overall WHOQOL-BREF. The mean overall WHOQOL-BREF score was 68.4%, with the lowest scores observed in the environmental domain (mean = 53.76%). Workplace mobbing levels were low to moderate (mean WPVB score = 17.87), with subscale reliabilities ranging from α = 0.78 to 0.95. Mobbing was negatively associated with social relationships and the environmental WHOQOL-BREF (ρ = –0.23 to –0.33). Regression analysis showed that cohabitation and higher resilience significantly predicted better WHOQOL-BREF outcomes, whereas mobbing was not a significant predictor. Mediation analysis (bootstrap N = 5000) indicated no significant indirect effect of resilience in the relationship between mobbing and WHOQOL-BREF. Conclusions: Resilience was identified as a key protective factor for nurses’ quality of life in emergency care settings. Although workplace mobbing was present at low-to-moderate levels, it was negatively associated with specific WHOQOL-BREF domains. Enhancing mental resilience among nurses may serve as a valuable strategy to mitigate the psychological effects of moral harassment in healthcare environments. Full article

Sexual health constitutes a fundamental aspect of overall well-being, with direct implications for individual development and the broader social and economic progress of communities. Promoting environments that ensure sexual experiences free from coercion, discrimination, and violence is a key public health priority. Sexuality, in this regard, should be understood as an inherent dimension of human experience, shaped by biological, cultural, cognitive, and ideological factors. Accordingly, sexual health education requires a holistic and multidimensional approach that integrates sociocultural, biographical, and professional perspectives. This study aims to examine the level of knowledge and training in sexual health among nursing students and healthcare professionals, as well as to assess the extent to which sexual health content is incorporated into nursing curricula at Spanish universities. A scoping review was conducted using the Dialectical Structural Model of Care (DSMC) as the theoretical framework. The findings indicate a significant lack of knowledge regarding sexual health among both nursing students and healthcare professionals, largely due to educational and structural limitations. Furthermore, sexual health education remains underrepresented in nursing curricula and is frequently addressed from a narrow, fragmented biomedical perspective. These results highlight the urgent need for the comprehensive integration of sexual health content into nursing education. Strengthening curricular inclusion is essential to ensure the preparation of competent professionals capable of delivering holistic, inclusive, and empowering care in this critical area of health. Full article

Background/Objectives: Evidence-based nursing practice (EBNP) is essential in high-acuity settings such as intensive care units (ICUs) and emergency departments (EDs), where nurses are frequently required to make time-critical, high-stakes clinical decisions that directly influence patient safety and outcomes. Despite its recognized importance, the implementation of EBNP remains inconsistent, with frontline nurses often facing barriers to accessing and applying current evidence. Methods: This descriptive, cross-sectional study systematically mapped and prioritized clinical questions generated by ICU and ED nurses at a tertiary hospital in South Korea. Using open-ended questionnaires, 204 clinical questions were collected from 112 nurses. Each question was coded and classified according to the Nursing Interventions Classification (NIC) taxonomy (8th edition) through a structured cross-mapping methodology. Inter-rater reliability was assessed using Cohen’s kappa coefficient. Results: The majority of clinical questions (56.9%) were mapped to the Physiological: Complex domain, with infection control, ventilator management, and tissue perfusion management identified as the most frequent areas of inquiry. Patient safety was the second most common domain (21.6%). Notably, no clinical questions were mapped to the Family or Community domains, highlighting a gap in holistic and transitional care considerations. The mapping process demonstrated high inter-rater reliability (κ = 0.85, 95% CI: 0.80–0.89). Conclusions: Frontline nurses in high-acuity environments predominantly seek evidence related to complex physiological interventions and patient safety, while holistic and community-oriented care remain underrepresented in clinical inquiry. Utilizing the NIC taxonomy for systematic mapping establishes a reliable framework to identify evidence gaps and support targeted interventions in nursing practice. Regular protocol evaluation, alignment of continuing education with empirically identified priorities, and the integration of concise evidence summaries into clinical workflows are recommended to enhance EBNP implementation. Future research should expand to multicenter and interdisciplinary settings, incorporate advanced technologies such as artificial intelligence for automated mapping, and assess the long-term impact of evidence-based interventions on patient outcomes. Full article

Background/Objectives: The integration of AI chatbots in nursing education, particularly in simulation-based learning, is advancing rapidly. However, there is a lack of structured evaluation models, especially to assess AI-generated simulations. This article introduces the AI-Integrated Method for Simulation (AIMS) evaluation framework, a dual-phase evaluation framework adapted from the FAITA model, designed to evaluate both prompt design and chatbot performance in the context of nursing education. Methods: This simulation-based study explored the application of an AI chatbot in an emergency planning course. The AIMS framework was developed and applied, consisting of six prompt-level domains (Phase 1) and eight performance criteria (Phase 2). These domains were selected based on current best practices in instructional design, simulation fidelity, and emerging AI evaluation literature. To assess the chatbots educational utility, the study employed a scoring rubric for each phase and incorporated a structured feedback loop to refine both prompt design and chatbox interaction. To demonstrate the framework’s practical application, the researchers configured an AI tool referred to in this study as “Eval-Bot v1”, built using OpenAI’s GPT-4.0, to apply Phase 1 scoring criteria to a real simulation prompt. Insights from this analysis were then used to anticipate Phase 2 performance and identify areas for improvement. Participants (three individuals)—all experienced healthcare educators and advanced practice nurses with expertise in clinical decision-making and simulation-based teaching—reviewed the prompt and Eval-Bot’s score to triangulate findings. Results: Simulated evaluations revealed clear strengths in the prompt alignment with course objectives and its capacity to foster interactive learning. Participants noted that the AI chatbot supported engagement and maintained appropriate pacing, particularly in scenarios involving emergency planning decision-making. However, challenges emerged in areas related to personalization and inclusivity. While the chatbot responded consistently to general queries, it struggled to adapt tone, complexity and content to reflect diverse learner needs or cultural nuances. To support replication and refinement, a sample scoring rubric and simulation prompt template are provided. When evaluated using the Eval-Bot tool, moderate concerns were flagged regarding safety prompts and inclusive language, particularly in how the chatbot navigated sensitive decision points. These gaps were linked to predicted performance issues in Phase 2 domains such as dialog control, equity, and user reassurance. Based on these findings, revised prompt strategies were developed to improve contextual sensitivity, promote inclusivity, and strengthen ethical guidance within chatbot-led simulations. Conclusions: The AIMS evaluation framework provides a practical and replicable approach for evaluating the use of AI chatbots in simulation-based education. By offering structured criteria for both prompt design and chatbot performance, the model supports instructional designers, simulation specialists, and developers in identifying areas of strength and improvement. The findings underscore the importance of intentional design, safety monitoring, and inclusive language when integrating AI into nursing and health education. As AI tools become more embedded in learning environments, this framework offers a thoughtful starting point for ensuring they are applied ethically, effectively, and with learner diversity in mind. Full article

Background/Objectives: Family spirituality is an important concept in family nursing that reinforces the meaning of the family’s existence. However, no studies on specific family intervention methods have been conducted to date. The purpose of this study was to verify the effect of family interventions using the family life review (FLR) program on changes to family spirituality. Methods: An FLR was conducted on six families having older adult members and undergoing family spiritual suffering, with two sessions spaced one week apart. The FLR was conducted using the Plot of Family Story (PFS), a tool for reviewing family history based on the concentric sphere family environment theory (CSFET). Semi-structured interviews and scoring using the Family Spirituality Index were conducted based on CSFET at three points in time: first before, and then after, the FLR, then again one month later, and changes in family spirituality were analyzed using mixed methods. Results: The families encountered family spiritual suffering in the family internal environment system, family system unit, and chrono system according to the CSFET. The FLR, when used with the PFS, was able to maintain, enhance, confer, and actualize family spirituality corresponding to the spiritual suffering being experienced by the target families. Conclusions: Family intervention through an FLR using the PFS can improve family spirituality in families undergoing family spiritual suffering. In this study, the PFS became a legacy for the family and raised awareness of the value of their existence. Full article

Introduction: Nurses are the largest group of healthcare workers, and healthcare managers should pay attention to the quality of work life and the health and working capacity of nurses in order to ensure a sufficient number of nurses and a stable workforce. Aim: The present study aimed to determine nurses’ quality of work life, work ability index and intention to leave the nursing profession and to examine the associations between nurses’ quality of work life, work ability index and intention to leave the nursing profession. Methods: An online cross-sectional study was conducted. A total of 498 nurses completed the instrument, consisting of demographic data, Brooks’ Quality of Nursing Work Life Survey (BQNWL), Work Ability Index Questionnaire (WAIQ) and questions on their intention to leave their current job or the nursing profession. Results: Most nurses had a moderate quality of work life (QWL) (73.7%) and a good work ability index (WAI) (43.78%). Men (p = 0.047), nurses who study (p = 0.021), nurses who do not have children (p = 0.000) and nurses who do not take care of their parents (p = 0.000) have a statistically significantly higher total WAIQ score. Most nurses (61.1%) had considered changing jobs in the last 12 months, and 36.9% had considered leaving the nursing profession. A statistically significant positive correlation was found between the total BQNWL and the total WAI. The study found no correlation between QWL, WAI and intention to change jobs or leave the profession, which was unexpected. Conclusions: To ensure the provision of necessary nursing care and a healthy working environment for nurses, it is necessary to regularly monitor QWL and WAI and take measures to ensure the highest quality of working life. Further longitudinal and mixed-methods research is needed to understand the relationship between QWL, WAI and intention to leave. Full article

This concept paper outlines an implementation strategy for a mandatory training programme using the ADDIE instructional design model for delivery to nurses and other health professionals in an interprofessional education (IPE) environment). Background: Competence in Basic Life Support (BLS) is a lifesaving requirement for health professionals in clinical settings to ensure patient safety and accreditation outcomes. It is essential that health professionals are supported in attending mandatory training, including BLS. To inform learning and teaching strategies, it is useful to apply theoretical perspectives to the development of mandatory staff training methods. However, various training models exist, and few are grounded in instructional design theory to the unique environment for BLS in IPE. Method: A theory-based implementation strategy is outlined for a mandatory interprofessional training programme including BLS, using the ADDIE model to enhance patient outcomes. ADDIE is an instructional design framework comprising five elements: Assess, Design, Develop, Implement and Evaluate; describing a learning methodology that can be readily applied to mandatory training in IPE. Results: Through its iterative capability, the ADDIE model promotes learner needs and rapid acquisition of clinical skills that improve training accessibility. The strategy can equip educators with teaching skills based on a robust theoretical model, with potential to promote nursing and health professional attendance for mandatory training. Conclusions: Mandatory health professional training that addresses a theory informed strategy framed by the ADDIE model can support interprofessional collaboration and consistent competency across healthcare teams. This strategy has potential to contribute by demonstrating how instructional design can be operationalised to improve the effectiveness and engaging approach to BLS training and education to the unique dynamics of an interprofessional environment. Full article

Background: Emotional safety is increasingly recognized as crucial for high-quality patient care, encompassing a patient’s sense of security, courteous treatment, being heard, and a peaceful environment. Purpose: The purpose of this study was to explore the perceptions of patients and providers (doctors and nurses) regarding emotional harm and safety in relation to hospitalized patients. Methods: We conducted a qualitative study in public-sector teaching hospitals in Peshawar, Pakistan. Data were collected after we obtained informed consent using individual interviews with 15 providers, namely, doctors (n = 7) and nurses (n = 8), and five focus group discussions (FGDs) with 25 hospitalized patients. Data from both the interviews and FGDs were analyzed using Braun and Clarke’s six-phase approach to thematic analysis. Results: The key themes revealed by the providers’ perspectives were factors contributing to emotional harm, staff-related factors, coping mechanisms and solutions, and the impact of prior experiences and involvement. The main themes that emerged from the patients’ perspectives were anxiety upon admission, the impact of communication, emotional stress due to treatment delays, systemic/bureaucratic challenges, financial burden, a lack of emotional support, and post-hospitalization concerns. The consistent perspectives shared by both patients and providers included the impact of systemic factors, communication issues, the role of staff attitude/behavior, financial concerns, and the influence of prior experiences. Conclusions: This study highlights the complex interplay of systemic, staff-related, and patient-specific factors. It suggests a need to improve communication, staff support, administrative processes, financial counseling, emotional support integration, and discharge planning to minimize harm and create a patient-centered environment. Full article

Healthcare abuse is a critical human rights and public health issue, particularly impacting medical interns and trainees who are vulnerable to mistreatment during their formative professional years. This cross-sectional study, conducted from February to June 2024, evaluated the prevalence and psychological impact of harassment and discrimination among 463 healthcare interns in Saudi Arabia from various specialties, including medicine, nursing, pharmacy, and dentistry. Using a self-administered online questionnaire, we found that mistreatment was widely reported, with female interns experiencing significantly higher rates of sexual harassment and gender-based discrimination. Common perpetrators included residents, lecturers, professors, nurses, and patients, with incidents most frequently occurring in surgical and internal medicine departments. Despite high prevalence, only 9% of interns reported the abuse due to mistrust in reporting systems or failure to recognize the behavior as abuse. These experiences were associated with significant psychological distress, including frustration, reduced motivation to learn, and higher DASS scores, particularly among female interns. The study underscores the need for institutional reforms, including policy development, cultural change, and effective reporting systems to ensure a safe and supportive learning environment for future healthcare professionals. Addressing abuse in medical training is essential for individual well-being and the sustainability and integrity of healthcare systems. Full article

Virtual reality is increasingly used in health sciences education, including healthcare, nursing, and medical education. Hence, this study provides an overview of the use of virtual reality within healthcare education, nursing education, and medical education through the analysis of published documents from 2010 to 2025. Based on the outcomes of this study, virtual reality emerged as an effective educational tool that can support students and health professionals. The immersive, realistic, and safe environments created in virtual reality allowed learners to enhance their knowledge and practice their skills, patient interactions, and decision-making without risking patient safety. Improvements in learning outcomes, including performance, clinical skills development, critical thinking, and knowledge acquisition were observed. Virtual reality also positively contributes toward a more holistic health sciences education as it increases students’ empathy and behavioral understanding. Finally, eight main research topics were identified and research gaps and future research directions are presented. Full article

Nursing students encounter several challenges as they progress through their educational journey, particularly in integrating theoretical knowledge with practical applications using simulation-based learning (SBL). This study aimed to comprehensively assess the effects of SBL on nursing competence, self-efficacy, and overall satisfaction among undergraduate nursing students at Tabuk University, Saudi Arabia. A total of 136 students participated in this study, which employed a mixed-methods sequential explanatory design including a quantitative cross-sectional survey complemented by qualitative interviews to capture a holistic view of their experiences with SBL. The findings revealed high levels of satisfaction and self-confidence among students participating in SBL, indicating its effectiveness as an academic tool for enhancing learning outcomes. Significant positive correlations were observed among nursing competence, satisfaction, and self-confidence in the SBL context. This suggests that successful engagement in this educational approach can lead to improved clinical skills and preparedness for real-world challenges. The qualitative findings further illuminated the emotional and cognitive engagement experienced by students during the SBL sessions. The participants emphasized the importance of skill mastery in a safe and controlled environment and the positive impact of advanced technologies, such as virtual simulations, on their learning experiences. Full article

Background/Objective: Frontline healthcare staff who contend diseases and mitigate their transmission were repeatedly exposed to high-risk conditions during the COVID-19 pandemic. They were at risk of mental health issues, in particular, psychological stress, depression, anxiety, financial stress, and/or burnout. This study aimed to investigate and evaluate the occupational stress of medical doctors, nurses, pharmacists, physiotherapists, and other hospital support crew during the COVID-19 pandemic in Saudi Arabia. Methods: We collected both qualitative and quantitative data from a survey given to public and private hospitals using methods like correspondence analysis, cluster analysis, and structural equation models to investigate the work-related stress (WRS) and anxiety of the staff. Since health-related factors are unclear and uncertain, a fuzzy association rule mining (FARM) method was created to address these problems and find out the levels of work-related stress (WRS) and anxiety. The statistical results and K-means clustering method were used to find the best number of fuzzy rules and the level of fuzziness in clusters to create the FARM approach and to predict the work-related stress and anxiety of healthcare staff. This innovative approach allows for a more nuanced appraisal of the factors contributing to work-related stress and anxiety, ultimately enabling healthcare organizations to implement targeted interventions. By leveraging these insights, management can foster a healthier work environment that supports staff well-being and enhances overall productivity. This study also aimed to identify the relevant health factors that are the root causes of work-related stress and anxiety to facilitate better preparation and motivation of the staff for reorganizing resources and equipment. Results: The results and findings show that when the financial burden (FIN) of healthcare staff increased, WRS and anxiety increased. Similarly, a rise in psychological stress caused an increase in WRS and anxiety. The psychological impact (PCG) ratio and financial impact (FIN) were the most influential factors for the staff’s anxiety. The FARM results and findings revealed that improving the financial situation of healthcare staff alone was not sufficient during the COVID-19 pandemic. Conclusions: This study found that while the impact of PCG was significant, its combined effect with FIN was more influential on staff’s work-related stress and anxiety. This difference was due to the mutual effects of PCG and FIN on the staff’s motivation. The findings will help healthcare managers make decisions to reduce or eliminate the WRS and anxiety experienced by healthcare staff in the future. Full article

Background: Nursing students often experience heightened levels of stress during clinical training due to the dual demands of academic and clinical responsibilities. These stressors, compounded by environmental and organizational factors, can adversely affect students’ well-being, academic performance, and the quality of patient care they deliver. Aim: This study aimed to identify the key stressors influencing nursing students’ perceptions of single-shift quality (SSQ) during clinical training and to examine how well students can predict the quality of their shift based on pre-shift expectations. Methodology: A cross-sectional survey design was implemented, collecting pre- and post-shift data from 325 nursing students undergoing clinical training in Alabama. The survey measured 13 domains related to workload, environmental conditions, organizational interactions, coping strategies, and overall satisfaction. Paired t tests and linear regressions were used to assess changes in perception and identify key predictors of SSQ. Results: This study found significant discrepancies between students’ pre- and post-shift evaluations across multiple domains, including internal environment, organizational interaction with clinical faculty/preceptors, and coping strategies (p < 0.001). Students also accurately predicted stable factors such as patient characteristics and external environment. Pre-shift expectations did not significantly predict post-shift experiences. Post-shift perceptions revealed that stress-coping strategies and collegiality were the strongest predictors of shift quality. Conclusion: Students enter clinical shifts with optimistic expectations that often do not align with actual experiences, particularly regarding support and stress management. The SSQ framework offers a valuable tool for identifying gaps in clinical training and guiding interventions that foster resilience and better alignment between expectations and real-world practice. Full article

Generative artificial intelligence (AI) is changing higher education. Understanding students’ perceptions, usage behaviour and ethical concerns is crucial for the responsible and sustainable use of AI in the academic environment. The aim of this study was to explore the perceptions, experiences and challenges of health sciences students in relation to the use of generative AI in their academic learning. A descriptive cross-sectional survey was conducted with 397 students enrolled in four undergraduate health-related degree programmes in Slovenia, including nursing, physiotherapy, dietetics and applied kinesiology. The data was collected using a validated 27-point scale. Students were generally favourable towards AI, especially in terms of its perceived usefulness, integration into their daily study routine and ethical considerations. Regression analyses revealed that frequency of AI use, duration of use, self-reported skill level and confidence in using AI significantly predicted perceived usefulness. Gender differences were found, with male students reporting higher perceived usefulness and fewer concerns. Students recognised the potential of generative AI but emphasised the importance of ethical guidance, digital literacy and equal access. Institutions should prioritise structured training and inclusive strategies to ensure meaningful, sustainable and responsible integration of AI into health education. Full article

The quality of living environments for older adults represents a critical component of social sustainability in an ageing society. Among various housing options, nursing homes are the most institutionalised form of elderly care and demand special attention regarding architectural design. This paper explores the impact of architectural and open space features on social sustainability in living environments for older adults. A comparative analysis of three Slovenian nursing homes is presented. The first two, built in the post-war period, were based on elevated architectural criteria inspired by Swedish human-centred housing design. The third was completed in 2021 in the post-COVID-19 era, which revealed the vulnerability of such housing typologies. An integrated methodological framework was developed by applying two complementary assessment tools: the Safe and Connected, developed by the authors to evaluate the spatial, health, and social resilience of nursing home environments, and the Well-being and Integration, addressing the role of open space with a particular emphasis on the identification of older adults with their environment and the facilitation of social resilience. Both tools evaluate indicators linked to the social dimension of quality of life for older adults. The results show a gradual improvement in architectural quality from the 1960s to the 1980s, followed by a partial decline in the contemporary case. The Swedish example scored highest across both tools. In contrast, the newest Slovenian facility scored surprisingly low in social integration, highlighting critical gaps in current nursing home design. This study demonstrates the value of applying interdisciplinary, tool-based evaluations in identifying design strategies that foster resilient and inclusive LTC environments, and the proposed framework may serve as a decision-making aid for architects, planners, and policymakers. This research highlights the importance of reintroducing human-oriented design principles to support socially sustainable nursing home environments. Full article