Search Results (906)

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

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

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

People living with HIV (PLHIV) are at an increased risk of progressing from Mycobacterium tuberculosis (TB) infection to TB disease. Tuberculosis preventive treatment (TPT) is recommended for PLHIV; however, its uptake remains suboptimal. In Zimbabwe, three months of weekly rifapentine and isoniazid (3HP) and six months of daily isoniazid (6H) are the most commonly prescribed TPT regimens. We explored barriers to TPT uptake among PLHIV from the perspective of healthcare workers (HCWs) in Zimbabwe. Facility nurses who had been implementing TPT for at least six months were invited to participate in in-depth interviews and/or focus group discussions conducted in March 2023. Audio recordings were transcribed into English, coded using NVivo 12 (QSR International), and analyzed thematically. Eleven HCWs participated in in-depth interviews and 15 in focus group discussions. Barriers were categorized as person- and health system-related. Person-related barriers included misconceptions about TPT, fear of adverse events, and pill burden. Health system barriers included stock-outs of TPT medications, limited HCW knowledge and skills to promote TPT, limited expertise in initiating TPT among children under five years of age, and limited access to chest radiography. Barriers to TPT uptake and completion remain in Zimbabwe and contribute to missed opportunities for TB prevention among PLHIV. TPT implementation could be strengthened through an uninterrupted supply of TPT medications, continuous training and mentorship of HCWs, and community engagement to improve awareness of the benefits and risks of TPT. Full article

Background/Objectives: Members of the LGBTQ+ community often have poorer health outcomes and less access to health services than cisgender and heterosexual populations, and many healthcare professionals remain insufficiently aware of the barriers faced by these patients. Community nurses, given their skills and competencies, can help patients overcome barriers and achieve greater inclusion. The aim of this project is to identify the barriers and facilitators detected by the primary care nursing team of the Málaga-Valle del Guadalhorce Health District (MVGHD) when providing holistic care to LGBTQ+ individuals. Methods: A sequential explanatory mixed-methods design (DEXPLIS) will be employed to robustly combine a quantitative baseline of professional attitudes with an in-depth qualitative exploration of institutional discourses. Phase I consists of a pilot cross-sectional study with cluster allocation of questionnaire versions in which primary healthcare nursing staff in the MVGHD will complete the validated Sexuality Attitudes and Beliefs Survey (SABS) with one group completing a version framed around LGBTQ+ patients and the other around the general population. Phase II consists of a qualitative descriptive study based on discourse analysis (DA) using in-depth semi-structured interviews, analyzed with ATLAS.ti 23. Conclusions: This study protocol is expected to provide an empirical framework to identify potential institutional barriers and attitudinal biases in nursing care, highlighting the potential need for targeted training programmes in sexual and reproductive health. The resulting protocol aims to contribute to health equity by offering practical resources to optimize ongoing clinical education in primary care settings. Full article

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

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

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

Introduction: This study explores obstetric providers’ perceptions of intimate partner violence (IPV) screening in the Chinese clinical setting, guided by the social–ecological model. Methods: Purposive sampling was employed to recruit eight obstetricians and 12 obstetric nurses from a tertiary general hospital in Suzhou, Jiangsu Province, China. Individual semi-structured interviews were conducted between December 2024 and September 2025. Results: Guided by the social–ecological model, this study examines factors influencing healthcare professionals’ engagement in intimate partner violence screening across four levels. A multilevel framework was distilled; four key themes were identified, including the intrapersonal level, interpersonal level, institutional level and community and policy level. (1) The intrapersonal level—healthcare professionals’ competence (knowledge base, communication skills, role identity, screening attitudes, and diagnostic ability); (2) the interpersonal level—interdisciplinary collaboration (internal referrals and external support); (3) the institutional level—hospital screening efficacy (screening resources and management systems); and (4) the community and policy level—social environment (policy support, educational resources, and cultural context). Conclusions: Multilevel factors impact IPV screening in China. These results indicate that a multidimensional model of intervention should be designed to promote IPV screening in China, including integrating IPV curricula into mandatory medical student training, enhancing interdisciplinary collaboration, conducting public education on IPV, implementing socio-cultural adjustments, challenging authoritative attitudes, and providing comprehensive social support. Full article

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

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

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

Background: People living with dementia (PLWD) are at increased risk for medical complications, including urinary tract infections (UTIs), which are often presented atypically with delirium or behavioral changes. These atypical presentations frequently prompt psychiatric consultation and complicated medical management. As the aging population grows, understanding how dementia influences UTI-related outcomes is critical for C-L psychiatrists working at the interface of medicine and psychiatry. Methods: This retrospective cohort study used the 2021 National Inpatient Sample (NIS) to identify adult inpatients with a principal diagnosis of UTI. Patients were stratified by the presence of a comorbid dementia diagnosis. Multivariate logistic and linear regression models adjusted for demographic, clinical, and hospital-level covariates were used to examine associations between dementia and outcomes: in-hospital mortality (primary), length of stay (LOS), hospital charges, and discharge disposition (secondary). Adjusted models included available demographic, socioeconomic, comorbidity, and hospital-level covariates, including age, sex, race/ethnicity, median household income quartile by patient ZIP code, insurance type, Charlson Comorbidity Index, hospital region, urban hospital location, and hospital teaching status. Results: Among 295,494 hospitalizations for UTI, 78,990 (26.7%) involved patients with dementia. Compared to those without dementia, PLWD were significantly older (mean age 82.5 vs. 69.5 years), more likely to be female, and had greater comorbidity burden. Adjusted analyses revealed that dementia was linked to higher odds of in-hospital mortality (aOR: 1.28, 95% CI: 1.03–1.58), longer LOS (+0.93 days, p < 0.01), and increased hospital charges (+$3243.50, p < 0.01). Additionally, PLWD had lower odds of discharge to home (aOR: 0.53) and higher odds of discharge to skilled nursing facilities (aOR: 1.94). Conclusions: Among patients hospitalized with a principal diagnosis of UTI, comorbid dementia was linked with higher in-hospital mortality, longer length of stay, higher hospital charges, and lower likelihood of discharge home. These findings should be interpreted in the context of important limitations of administrative data, including residual confounding and inability to distinguish symptomatic UTI from asymptomatic bacteriuria. Full article

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