Search Results (805)

Tourist guides remain understudied in tourism workforce research, particularly regarding the conditions shaping satisfaction and career retention. This study examines how cultural tourism itinerary characteristics are associated with tourist guides’ job satisfaction and career retention intentions. Data were collected through a convenience sample survey of 127 active tourist guides in Portugal. Grounded in the Job Satisfaction Survey and the Theory of Planned Behaviour frameworks, the study utilised exploratory factor analysis and multiple linear regression to analyse the data. Results indicate positive associations between itinerary characteristics, job satisfaction and career retention intentions, with Components (accommodation, meals, accessibility) and Sustainability emerging as the strongest predictors. These findings extend the Job Demands–Resources model to a supervisory-free work context and highlight itinerary design as a previously underexplored human resource management mechanism shaping workforce outcomes in tourism, with implications for tour operators, destination managers and policymakers. Full article

Background/Objectives. Country-level evidence on the economic footprint of home care nursing is still scarce, particularly in systems where tariffs for community-based nursing are lacking. In Italy, recent laws have expanded home care; yet planning and funding remain constrained by the absence of robust micro-costing evidence. Objectives. To estimate the accounting cost of home care nursing visits in Italy using a bottom-up micro-costing approach and to identify the main cost drivers influencing expenditure. Methods. A multicentre, cross-sectional study was conducted. Data were collected in two phases: (1) a national survey of 3949 home care nurses from 70 Local Health Authorities (April–October 2023), describing workload, travel time, and the most frequently performed activities; and (2) a time-and-motion study of 527 consecutive home visits performed by 83 nurses in three Local Health Authorities (March 2024). Direct costs were estimated from the Italian National Health Service perspective and included nursing time, travel time and transportation, back-office activities, and materials. Personnel costs were derived from national collective labour agreements and inflation-adjusted. A base-case scenario estimated accounting costs directly measured in the study. An extended, illustrative scenario explored the economic value of nursing activities by applying existing outpatient tariffs. Deterministic and probabilistic sensitivity analyses (10,000-iteration Monte Carlo simulation) were performed. Results. The mean accounting cost of home care nursing was €27.78 per patient per day. At the provider level, the corresponding daily cost per nurse was €190.00, assuming a mean caseload of 6.84 patients per nurse per shift. In the extended scenario, the imputed economic value of nursing activities increased the estimated daily cost to €120.81 per patient and €826.32 per nurse. Sensitivity analyses identified organizational factors (particularly the number of patients per shift and the number of activities per visit) as the dominant cost drivers, while material and transportation costs had a comparatively limited impact. Conclusions. Home care nursing in Italy appears to be delivered at a relatively low accounting cost, with organizational factors playing a greater role than unit prices in determining expenditure. The absence of a dedicated reimbursement framework for nursing activities may result in a substantial under-recognition of the economic value of home-based nursing care. These findings provide preliminary evidence to support workforce planning, reimbursement policies, and the sustainable development of territorial care services. Full article

Background: With the rapid aging of populations worldwide, strengthening the professional capacity of long-term care (LTC) workers has become a critical priority for health systems. While competency-based training frameworks are widely implemented, it remains unclear which domains of competency are most closely associated with ethical professionalism in daily care practice. Methods: A cross-sectional survey was conducted with 268 LTC workers across home-based, community-based, and institutional settings in Taiwan. Multiple linear regression analyses were performed to examine the associations between core competency domains and perceived ethical professionalism. Results: Participants reported relatively high levels of overall competency and ethical professionalism. Among the competency domains, interpersonal communication (β = 0.345, p < 0.001), psychological support (β = 0.184, p = 0.020), and teamwork (β = 0.111, p = 0.045) were significantly associated with ethical professionalism. In contrast, technical competencies, including physical care, daily living care, and emergency management, were not significantly associated (p > 0.05). Conclusions: The findings suggest that ethical professionalism in LTC practice is more strongly associated with relational and psychosocial competencies than with technical skills. These results highlight the importance of incorporating communication, emotional support, and teamwork training into workforce development programs. Prioritizing these competencies in training frameworks may be associated with improved care quality, workforce sustainability, and person-centered care delivery in aging societies. Full article

Across four decades of AI deployment, the same six human challenges (trust calibration, reliance behavior, cognitive engagement, skill retention, accountability, and transparency) recur, yet fragmentation across research communities obscures this continuity and limits knowledge transfer. Functionally similar phenomena are repeatedly relabeled (a jangle fallacy): what aviation researchers call “automation complacency,” decision scientists call “algorithm appreciation,” and LLM researchers describe as “over-reliance.” This systematic review synthesizes 152 papers spanning aviation, healthcare, manufacturing/supply chain, and cross-domain contexts across three AI technology generations: decision support systems, autonomous systems, and large language model (LLM) agents. We introduce the Collaboration Convergence Framework (CCF), a 6 × 3 matrix with solution-maturity indicators that maps each challenge across generations. The framework shows that Gen 3 designers can transfer decades of evidence from automation and decision support research (particularly reliance calibration, cognitive forcing, and skill maintenance) rather than rediscovering them. Cross-generational synthesis also isolates three Gen 3 phenomena without direct precedent in earlier generations: epistemia (attributing genuine knowledge to LLMs based on surface fluency), attribution ambiguity in co-creation, and motivational withdrawal. We distill twelve transferable design principles and propose ten research directions, prioritizing skill-retention interventions and accountability frameworks. These findings carry direct sustainability implications aligned with Industry 5.0: protecting workforce capability under increasing automation (SDG 8), reducing duplicated research effort through cross-generational knowledge reuse (SDG 9), and supporting responsible deployment by treating collaboration risks as predictable rather than novel (SDG 12). The CCF provides conceptual infrastructure for cumulative learning across AI generations and industries. Full article

Background: Nurse Practitioners (NPs) are increasingly integrated into pediatric inpatient teams in response to evolving healthcare needs and workforce challenges. However, evidence describing how NP roles are operationalized, implemented, and sustained in general pediatric ward settings remain fragmented. Objective: This scoping review will synthesize international literature on NP roles in general pediatric inpatient settings, with a focus on determinants of role implementation. Guided by the Participatory, Evidence-based, Patient-focused Process for Advanced Practice Nursing (PEPPA) framework, this review will examine implementation strategies, outcomes, timelines, facilitators, barriers, and required resources to inform future integration and evaluation. Methods: This scoping review will be conducted in accordance with Joanna Briggs Institute (JBI) methodology and reported following PRISMA-ScR guidelines. A PRESS-reviewed search strategy will be applied to Scopus, MEDLINE, PsycInfo, CINAHL, Cochrane Central, ProQuest, grey literature, and reference lists for English and French language studies published from 2016 onward. Studies relating to NP roles in general pediatric wards internationally will be included. Data extraction and synthesis will be structured using the PEPPA framework’s implementation domain. Findings will be summarized descriptively and presented in tables and narrative synthesis. Conclusions: A targeted synthesis focused on determinants of NP role implementation in this context is needed. This review will clarify how NPs roles have been integrated in general pediatric wards, highlight enabling and constraining factors, and will identify gaps to guide future research, practice redesign, and policy development. Full article

Background/Objectives: Sustaining a stable and competent workforce in neonatal intensive care units (NICUs) is critical for ensuring high-quality care for vulnerable neonates. However, workforce-related challenges such as job dissatisfaction and turnover remain significant concerns in high-acuity settings. Guided by the ecological model, this study aimed to examine resilience, communication competence, and the nursing work environment as multilevel factors associated with nursing workforce sustainability, with job satisfaction serving as a proxy indicator related to workforce retention and sustainability. Methods: A descriptive cross-sectional survey was conducted among 145 NICU nurses from three tertiary and three general hospitals in South Korea. Data were analyzed using descriptive statistics, independent t-tests, one-way ANOVA, Pearson’s correlation coefficients, and multiple regression analyses using SPSS version 29.0. Results: Job satisfaction was positively associated with resilience (r = 0.67, p < 0.001), communication competence (r = 0.52, p < 0.001), and the nursing work environment (r = 0.57, p < 0.001). Multiple regression analysis indicated that resilience (β = 0.43, p < 0.001), nursing work environment (β = 0.30, p < 0.001), communication competence (β = 0.15, p = 0.040), and employment in a tertiary hospital (β = 0.12, p = 0.038) were significant factors associated with job satisfaction, explaining 55.1% of the variance (adjusted R²) in job satisfaction (F = 30.42, p < 0.001). Conclusions: Job satisfaction, used as a proximal indicator related to workforce sustainability, was associated with multilevel factors across intrapersonal, interpersonal, and organizational domains. Although resilience showed the strongest association, communication competence and the nursing work environment also showed meaningful associations with job satisfaction. These findings highlight the need for integrated, multilevel strategies to support nursing workforce sustainability and sustained nursing practice in NICU settings. Full article

Background: PPPs are central to Saudi Arabia’s Vision 2030 healthcare transformation, yet evidence on their impact on accessibility, quality, and sustainability remains limited. The purpose of this study was to evaluate the perceived associations between PPP implementation under Vision 2030 and three healthcare system outcomes—service accessibility (geographical, financial, technological), care quality (clinical outcomes, patient satisfaction, efficiency), and reform sustainability (economic, operational, adaptive)—from the perspectives of healthcare professionals and patients in Saudi Arabia. Methods: A cross-sectional, mixed-methods design was employed. Surveys were administered to 150 healthcare professionals and 210 patients at PPP-operated facilities (response rates of 61.2% and 65.6%, respectively). Descriptive and inferential statistics—including t-tests, ANOVA, chi-square tests, and multiple regression analysis adjusted for age, sex, education, household income, comorbidities, and facility type were used to assess associations between PPP initiatives and outcomes. Instrument reliability was confirmed (Cronbach’s α ≥ 0.7), and content validity was supported by an expert-panel content validity index of 0.91. Thematic analysis of open-ended responses captured stakeholder perceptions and challenges (inter-coder κ = 0.83). Results: Among professionals, 56.6% reported improved accessibility following the implementation of PPP, with 60.6% endorsing telemedicine as a key facilitator. However, 64.6% indicated financial access remained unchanged or worsened due to persistent out-of-pocket expenditures, and a statistically significant urban–rural gap was observed (p = 0.008). Quality indicators showed positive trends, including improved patient outcomes (52%), reduced waiting times (60.6%), and high satisfaction with hygiene and safety (74%). Sustainability assessments were cautiously favorable (mean financial viability = 3.4/5), though subsidy dependence remained a concern. Adjusted regression analysis identified financial accessibility (β = 0.31, p < 0.001) and reduced waiting times (β = 0.23, p = 0.005) as variables significantly associated with patient-reported outcomes. Conclusions: PPPs were associated with measurable improvements in healthcare accessibility, quality, and efficiency in Saudi Arabia. However, achieving the Vision 2030 objectives requires reforms that address financial equity, service distribution, workforce nationalization, and governance. Full article

Modular construction advances sustainability and is reshaping designer competencies, making workforce development critical to industry transition. Existing competency models rely mainly on expert interviews and Delphi methods, offering limited quantitative evidence on role-specific labor-market demands, causal relationships among competencies, or experience-based perceptual differences. This study presents a preliminary, data-driven competency-mapping study for modular construction designers by integrating BERTopic, Ward clustering, CVR, Bayesian BWM, and Fuzzy DEMATEL. Applied to 243 job postings from six countries, the text-mining stage identifies a candidate competency structure of 3 domains, 9 categories, and 36 performance statements. This candidate structure was then examined through an exploratory survey of 30 Korean respondents. The results suggest that Codes and Compliance represents the most clearly recognized high-consensus competency area within this local validation sample, whereas Modular Construction shows an indicative experience-related divergence in perceived causal position. Given the small and uneven subgroup sample and the formative state of Korea’s modular construction industry, the findings should be interpreted as preliminary evidence rather than as a validated competency framework or a confirmed expert–novice model. The study contributes a reproducible mixed-method workflow, a candidate competency map, and an illustrative maturity prototype for future validation and refinement. Full article

The transition toward Industry 5.0 in sustainable construction demands a radical reconceptualisation of workforce development, moving beyond purely technical training to embrace human-centricity, digitalisation, green competencies, and socio-cognitive resilience. Traditional vocational and higher education systems have largely failed to bridge the gap between emerging construction industry demands and the competencies possessed by current and future professionals. This systematic review investigates how Learning Factories’ 5.0 immersive, experiential, and technology-rich educational environments can address these gaps in sustainable construction contexts. Drawing on a synthesis of 71 peer-reviewed publications spanning 2015–2026 and supplemented by targeted construction-domain literature, this study pursues three objectives: (1) identifying core competencies for Industry 5.0 readiness in sustainable construction, (2) examining how Learning Factories 5.0 support the development of these competencies, and (3) proposing a competency-driven framework for integrating Learning Factories 5.0 into sustainable construction education and training. Seven transdisciplinary competency clusters are identified—Attitude toward Digitalisation, Technical–Green Proficiency, Information and Data Literacy, Digital Security, Collaborative Systems Thinking, Adaptive Problem-Solving, and Reflective Sustainability Practice—and a theoretically derived, eight-phase Construction Learning Factory 5.0 (CLF5.0) Framework is proposed as a conceptual architecture for future empirical development and institutional adaptation. The framework is presented as a generative starting point rather than a prescriptive model, and its effectiveness in diverse construction education contexts requires empirical validation through future implementation studies. Findings reveal that while Learning Factories offer transformative potential, critical barriers remain in terms of economic feasibility, faculty development, industry–academia alignment, and empirical validation. This paper contributes a construction-specific competency architecture and implementation pathway to support the industry’s transition toward a sustainable, human-centric, and Industry 5.0-aligned future. Full article

Background: Caring for older adults with multimorbidity represents one of the most challenging aspects of contemporary nursing practice. While research has examined clinical outcomes and care models, limited attention has been given to how nurses develop resilience and adapt their professional practice to meet these complex care demands. This study aimed to examine how nurses build resilience and adapt their professional practice when caring for older adults with multimorbidity in acute care environments. Methods: This qualitative study employed in-depth semi-structured interviews with 15 registered nurses across general and specialized hospital settings. Data were analyzed using interpretive phenomenological analysis to understand the essence of nurses’ adaptation and resilience-building experiences. Results: Three superordinate themes emerged: (1) Professional evolution through complexity navigation, (2) Emotional resilience and meaning-making in challenging care situations, and (3) Collaborative networks as sources of strength and learning. Nurses demonstrated remarkable capacity for professional growth, developing sophisticated coping mechanisms and finding meaning in their challenging work. Conclusions: Nurses caring for older adults with multimorbidity undergo significant professional development, building resilience through experiential learning, peer support, and meaning-making processes, though these gains are accompanied by real emotional costs, including moral distress and exhaustion. Understanding these adaptation mechanisms is crucial for supporting nursing workforce sustainability and optimizing patient care quality. Full article

Background: Healthcare systems globally continue to experience persistent workforce and system-level challenges as increased workloads, lasting wellbeing impacts, and retention issues remain following the pandemic. To inform strategies and interventions to address these issues, this paper explored the workplace experiences of Victorian (Australia) frontline healthcare workers with parenting responsibilities during the COVID-19 pandemic. Methods: A total of 39 frontline healthcare workers from a large metropolitan hospital were interviewed between October 2020 and February 2021. Reflexive thematic analysis was used to analyse transcripts. Results: Three superordinate themes and five subordinate themes were identified. Themes highlighted the significant pressure that rapid workplace changes placed on healthcare staff and leaders, affecting their physical, mental, and relational health. Support from peers and supervisors was protective, though this increased demands on supervisors themselves. While many staff reported pride in their work, some experienced reduced career satisfaction and concerns about lasting psychological impacts. Conclusions: This study identifies how workplace supports operate through communication transparency, leadership capacity, and protected peer-support space, translating to organisational priorities for the post-pandemic workforce. In the context of ongoing workforce shortages and heightened demands post-pandemic, these findings underscore the importance of strengthening leadership capacity, embedding sustainable workplace supports, and addressing the psychological needs of healthcare staff. Such system-level responses are essential for pandemic recovery, improving workforce retention and staff wellbeing in the modern healthcare environment. Full article

Rural and remote health systems continue to face persistent workforce challenges that affect the delivery of chronic disease care, including diabetes management. Mentorship is widely recognised as a valuable strategy for supporting health professionals, with demonstrated benefits for practice development and workforce sustainability. However, many mentorship approaches are developed in well-resourced settings and assume stable infrastructure, protected time, and workforce capacity. These assumptions may not align with the realities of rural and remote practice, where service pressures and resource constraints shape everyday care. This commentary examines how mentorship can be designed for constrained health systems. It proposes a systems-oriented perspective that positions mentorship as part of routine practice rather than as a separate professional development activity. Emphasis is placed on flexibility, co-design, and cultural safety, with attention to how mentorship can be integrated within workforce development pathways. This reframing has implications for strengthening rural health services by supporting continuous, context-responsive learning within routine practice. More broadly, this approach offers a scalable pathway to workforce strengthening in geographically dispersed and resource-variable health systems. Full article

Background: Burnout is a relevant occupational health concern in Emergency Medical Services (EMSs), with potential implications for workforce well-being, occupational health, and the sustainability of prehospital care. Although burnout has been widely studied among healthcare professionals, evidence concerning Emergency Medical Technician (EMT) students remains limited. This exploratory study aimed to estimate high burnout prevalence among EMT students and practising EMT professionals in Madrid, Spain, describe burnout dimensions in both groups, and examine sociodemographic correlates of high burnout status. Methods: A cross-sectional comparative study was conducted between March and June 2024 using a convenience sample of 85 participants: 43 EMT students and 42 practising EMT professionals. Burnout was assessed using validated Spanish versions of the Maslach Burnout Inventory: the MBI-SS for students and the MBI-HSS for professionals. Because these instruments are population-specific and rely on different norms and thresholds, between-group comparisons of raw scores were interpreted as exploratory. Descriptive analyses, between-group comparisons with effect sizes, correlation analyses, and an exploratory binary logistic regression model were performed. Results: High burnout was identified in 22 EMT students (51.2%) and 23 practising EMT professionals (54.8%), with no statistically significant between-group difference detected (p = 0.73; Cramer’s V = 0.04). Between-group comparisons of burnout dimensions showed small effect sizes for Emotional Exhaustion (Cohen’s d = 0.17), Depersonalisation (Cohen’s d = 0.24), and Personal Accomplishment (Cohen’s d = −0.26). Age was positively associated with Emotional Exhaustion (r = 0.29, p = 0.008) and Depersonalisation (r = 0.24, p = 0.028), and negatively associated with Personal Accomplishment (r = −0.26, p = 0.019). In the exploratory adjusted logistic regression model, age was associated with high burnout status (OR = 1.05; 95% CI 1.01–1.10; p = 0.017), whereas group and sex were not significant correlates. Conclusions: High burnout levels were observed in both EMT students and practising EMT professionals in this regional exploratory sample. However, the findings should be interpreted cautiously due to the cross-sectional design, convenience sampling, modest sample size, limited statistical power, and use of population-specific burnout instruments. These results suggest that burnout-related distress may be relevant across the EMT training-to-practice pathway and support the need for larger longitudinal and multicentre studies incorporating occupational, educational, and organisational variables. Full article

Background: The National Research Mentoring Network (NRMN) aims to enhance capacity in the biomedical research workforce through mentorship, professional development, and networking. This study focuses on the Strategic Empowerment Tailored for Health Equity Investigators (NRMN-SETH) program, which supports early-stage investigators (ESIs), including those from underrepresented groups, in developing grant-writing skills. Using a realist evaluation framework, this study explores the contexts, mechanisms, and outcomes contributing to the program’s effectiveness. Methods: A directed content analysis approach was employed, guided by the realist evaluation framework. Data sources included speaker slides, moderator notes, and participant observations from the 2024 RCMI NRMN-SETH session. Context-mechanism-outcome configurations were analyzed to identify key stakeholders, enabling factors, and barriers to success. Results: Five key mechanisms emerged: social support, peer accountability, knowledge of grant-writing strategies, technical grant-writing knowledge, and access to mentoring. Critical contexts included protected time for grant writing, access to subject-matter experts, and participant readiness. Institutional leadership support and cross-institutional collaborations were identified as essential for sustainability. Conclusions: The NRMN-SETH program effectively supports ESIs through mentorship and technical guidance, fostering equitable participation in biomedical research. Future efforts should focus on institutional investment in mentorship, grant readiness, and expanded access to subject-matter experts to enhance the program’s scalability and long-term impact. Full article

The dynamic development of the digital economy, accompanied by changes in the employment structure and the rise in the knowledge workforce, has led to growing interest in the concept of democratic leadership as a foundation for organisational sustainable development. Highly skilled knowledge workers seek to participate in decision-making processes, value autonomy, and expect their work to provide satisfaction and a sense of fulfilment. The transition towards sustainable development requires a new approach by leaders in managing knowledge workers. This paper presents the results of a study aimed at identifying the relationships between democratic leadership style, job satisfaction, and performance of knowledge workers. These goals are achieved through the analysis of a survey of 396 knowledge workers whose work involved the extensive use of IT in Polish companies. Structural equation modelling is used to analyse the survey data. The results indicate that the democratic leadership style has a positive effect on job satisfaction, which in turn positively influences employee job performance. The analysis further reveals that job satisfaction mediates the relationship between democratic leadership and employee performance. The findings are discussed in the context of the leadership challenges associated with sustainable organisational development in the digital economy. Full article