Search Results (58)

Background/Objectives: Turnover intention among intensive care unit (ICU) nurses remains consistently higher than that observed in other clinical departments. A weakened professional identity and exposure to ethically challenging situations may further intensify nurses’ intention to leave. This study aimed to examine the influence of moral distress, person-centred care, and nursing professional pride on turnover intention among ICU nurses in South Korea. Methods: A descriptive cross-sectional design was employed using a convenience sample of 203 ICU nurses from three general hospitals in South Korea. Data were obtained between 26 September and 31 October 2024 and analysed using IBM SPSS Statistics for Windows, version 29.0.2.0, with t-tests, one-way analysis of variance, Pearson’s correlation coefficients, and stepwise multiple regression analysis. Results: Two subdomains of nursing professional pride—role satisfaction and willingness to stay—along with gender (male) and the futile care subdomain of moral distress were the main factors influencing turnover intention. These variables collectively explained 24.9% of the variance in turnover intention (F = 17.78, p < 0.001). Conclusions: Strengthening nursing professional pride—particularly role satisfaction and willingness to stay—and reducing futile care-related moral distress may help lower ICU nurses’ turnover intention. Organisational strategies, including ethical management programmes and supportive policies, are recommended to enhance nursing professional pride, alleviate moral distress, and promote long-term nurse retention. Full article

Biophilic designs and elements have been the focus of numerous studies due to their potential impact on key marketing outcomes including satisfaction, word-of-mouth, and revisit intentions. However, previous studies have mainly relied on simplified image-based experiments that focused only on the presence or absence of biophilic elements, overlooking the quality of these designs as hotel guests actually experience them. This study aimed to investigate the quality of actual biophilic elements in hotel service settings and their impact on guest well-being, perceived value, and patronage intentions while also exploring the moderating effects of guest delight. The study employed a self-administered questionnaire survey to collect data from a total of 428 guests who had already stayed at hotels with biophilic designs/elements in Egypt. Using SmartPLS 3.0, a PLS-SEM analysis was performed to test the study hypotheses and conceptual model. The findings revealed that the high quality of biophilic designs/elements in hotels significantly affected guest well-being and perceived value, which eventually supported revisit intentions and willingness to pay a premium. The results also affirmed the moderating effects of guest delight on the proposed model. This study addresses a notable knowledge gap and provides valuable managerial implications regarding hotel biophilic designs. Full article

This paper explores the role of personalisation and predictive marketing in Croatian tourism and analyses how behavioural strategies can enhance the tourist experience and increase visitor loyalty. In today’s competitive tourism market, personalised marketing strategies have become a key factor in attracting and retaining tourists. Based on the theoretical framework and previous research, hypotheses were formulated on various aspects of behavioural marketing, such as the impact of personalisation on destination choice, the perception of marketing effectiveness by different demographic groups and the correlation between tourists’ satisfaction and their willingness to revisit a destination. The aim of this study was to test six hypotheses relating to the personalisation of marketing messages, demographic factors and their correlation with tourists’ willingness to revisit the destination. Using a quantitative methodology, a survey was conducted among 415 tourists who had visited the Croatian city of Vodice. A total of 257 questionnaires were completed. The data was analysed using descriptive statistics, correlation analysis and regression models to identify the most important factors influencing tourists’ behaviour and preferences. The results show that personalised marketing messages have a positive impact on tourists’ decision to visit the destination. In addition, this study shows that demographic factors such as gender, age and education significantly influence the perception of marketing effectiveness. Tourists who received predictive marketing messages expressed higher satisfaction with their stay and showed a greater willingness to visit the destination again than those who did not receive personalised offers. These results underline the importance of integrating behavioural strategies into marketing activities to build tourist loyalty and improve the overall tourism experience. Based on the research findings, further application of these marketing approaches is recommended to increase competitiveness and attract more loyal tourists. Full article

As the texture skeleton of the traditional village, the street space is the main area for tourists to visit in traditional villages; it is regarded as the spatial conversion place of human flow and the space frequently visited by tourists. Accumulating evidence shows that the visual quality of street spaces has an effect on pedestrians’ walking behaviors in urban areas, but this effect in traditional villages needs to be further explored. This paper takes Huangcun Village, Yixian County, Huangshan City, as the research area to explore the influence of the objective visual factors of street spaces on tourists’ subjective stay willingness. First, an evaluation system of the visual quality of street spaces was developed. With the assistance of computer vision and deep learning technologies, semantic segmentation of Huangcun Village street view images was performed to obtain a visual quality index and then calculate the descriptive index of Huangcun Village’s street space. Then, combining the data of tourists’ stay willingness with the visual quality of the street space, the overall evaluation results and space distribution of tourists’ stay willingness in Huangcun Village were predicted using the Trueskill algorithm and machine learning prediction model. Finally, the influence of the objective visual quality of the street space on tourist subjective stay willingness was analyzed by correlation analysis. This research could provide some useful information for street space design and tourism planning in traditional villages. Full article

Introduction: Falls pose a significant health risk to older adults, with a reported prevalence of 31.6% among Saudi older adults. Medication-related falls are a preventable cause of morbidity and mortality. This study aimed to assess fall risk, evaluate knowledge of fall-risk-increasing drugs, and examine the impact of pharmacist counseling on community-dwelling older adults in Jazan, Saudi Arabia. Methods: A cross-sectional survey was conducted from December 2023 to March 2024 among 391 community-dwelling individuals aged ≥60 years in Jazan, Saudi Arabia. Fall risk was assessed using the Arabic Stay Independent screening tool, which remains unvalidated in Arabic-speaking populations. Participants answered demographic questions and reported any pharmacist counseling on medication in the past six months. Knowledge of prescription and over-the-counter fall-risk-increasing drugs was evaluated. Multivariable logistic regression and ordered probit models were used to analyze factors associated with fall risk and drug knowledge. Results: Approximately 57% of the participants were at risk of falling. Only 11.5% demonstrated good knowledge of prescription fall-risk-increasing drugs, whereas 24.6% showed good knowledge of over-the-counter fall-risk-increasing drugs. Age (OR, 1.07; 95% CI, 1.00–1.14; p = 0.05), arthritis (OR, 5.73; 95% CI, 2.51–13.06; p < 0.001), obesity (OR, 6.00; 95% CI, 2.33–15.46; p < 0.001) and diabetes (OR, 2.79; 95% CI, 1.38–5.64; p = 0.004) were associated with increased fall risk. Those who received pharmacist counseling had a greater likelihood (95% CI, 0.020–0.167; p = 0.01) of being in the very likely category of willingness to discuss medication changes. Conclusions: The findings highlight the role of pharmacist counseling and recommend improving fall prevention through medication reviews for arthritis and diabetes patients, standardized counseling protocols, and implementation of the Stay Independent screening tool for risk assessment in older adults. Full article

Pre-trip anxiety is a critical yet understudied factor influencing participation and engagement in Outdoor Experiential Education (OEE) programs. Anxiety can serve as both a motivator and a barrier, shaping participants’ willingness to engage in challenging activities. This study examines the sources, predictors, and temporal progression of pre-trip anxiety among OEE participants, with a focus on experience level, gender differences, and activity type. Using a cross-sectional design, data were collected from students and staff at two Midwestern universities across three time points leading to an OEE program. Measures included the State–Trait Anxiety Inventory (STAI) and a course-specific worry scale assessing concerns such as physical ability, social dynamics, and environmental risks. Results indicate that experience level can predict anxiety, with less experienced participants reporting higher levels of concern. Gender differences were also observed, with female participants exhibiting greater pre-trip anxiety, particularly in water-based activities. However, anxiety remained relatively stable across time intervals, suggesting that interventions may be effective at multiple stages before a program begins. These findings have practical implications for OEE design, including targeted pre-trip interventions, adjusted program marketing, and tailored support strategies to reduce barriers to participation and enhance student preparedness. Full article

This study explores the impact of green transformational leadership (GTL) on employee retention in the hospitality sector, with a specific focus on the mediating roles of employee satisfaction and perceived green organizational support (PGOS). Grounded in self-determination theory and organizational support theory, the research examines both the direct and indirect effects of GTL on employee retention. GTL fosters a sustainability-driven work environment, motivating employees through shared environmental values, which enhances their job satisfaction and perceived organizational support. These factors, in turn, strengthen employees’ commitment and willingness to stay within the organization. Using SmartPLS 3 for structural equation modeling (SEM), data collected from hospitality employees were analyzed to assess the hypothesized relationships. The findings confirm that GTL positively influences employee retention, both directly and indirectly, through the mediating effects of employee satisfaction and PGOS. This study contributes to the growing body of knowledge on sustainable leadership by highlighting the crucial role of green leadership practices in improving employee retention in environmentally conscious organizations. Implications for managers and policymakers in the hospitality sector are discussed, emphasizing the need for sustainability-driven leadership approaches to enhance workforce stability. Full article

Cancer survivors face numerous challenges, and digital health interventions can empower them by enhancing self-efficacy and patient activation. This prospective study aimed to assess the impact of a mHealth app on self-efficacy and patient activation in 166 breast and colorectal cancer survivors. Participants received a smart bracelet and used the app to access personalized care plans. Data were collected at baseline and follow-ups, including patient-reported outcomes and clinician feedback. The study demonstrated positive impacts on self-efficacy and patient activation. The overall trial retention rate was 75.3%. Participants reported high levels of activation (PAM levels 1–3: P = 1.0; level 4: P = 0.65) and expressed a willingness to stay informed about their disease (CASE-Cancer factor 1: P = 0.98; factor 2: P = 0.66; factor 3: P = 0.25). Usability of the app improved, with an increase in participants rating the system as having excellent usability (from 14.82% to 22.22%). Additional qualitative analysis revealed positive experiences from both patients and clinicians. This paper contributes significantly to cancer survivorship care by providing personalized care plans tailored to individual needs. The PERSIST platform shows promise in improving patient outcomes and enhancing self-management abilities in cancer survivors. Further research with larger and more diverse populations is needed to establish its effectiveness. Full article

The COVID-19 pandemic has significantly disrupted the global food supply chain, concurrently eroding consumer trust in imported food products. We conducted multi-round tracking surveys of Chinese consumers nationwide in December 2020 and January, March, April, May, July, and October 2021 to examine the stigmas induced by COVID-19 on imported cold-chain food. Results revealed that COVID-19 has induced a long-lasting stigma of imported cold-chain food among Chinese consumers. The mean willingness to pay for beef steak from the U.S., Australia, and Brazil decreased by about 4 yuan, 3 yuan, and 3 yuan, respectively, compared to that for the corresponding product before the pandemic. The results also showed that respondents’ risk perception of imported cold-chain food decreased slightly in the short term and then stayed at a high level. Elderly consumers and those with children were more likely to perceive a high risk of imported cold-chain food associated with COVID-19. Our results indicated that the stigmas of imported cold-chain food caused by COVID-19 persistently impacted consumer food behavior. Identifying ways to recover consumer trust in imported food is essential to boost consumer demand with the recovery of the global food supply chain. Full article

Background/Objectives: Audio and audiovisual distraction can be effective additive tools to reduce anxiety and pain in patients receiving outpatient procedures (OP). Audiovisual distraction tools already showed positive effects on pain perception in some urological procedures. To identify the effects of audio and audiovisual distraction on pain and anxiety in patients receiving perineal prostate biopsy (PPB), we performed a prospective randomized controlled study. Methods: We recruited 168 male patients undergoing PPB which were randomized into three groups: a control group (CG), an audio distraction group (ADG) and an audiovisual distraction group (AVDG). The CG received no intervention, while the ADG received audio distraction and the AVDG received audiovisual distraction while PPB was performed. The primary endpoint was pain perception, measured in the Numeric Rating Scale (NRS) and Visual Analogue Scale (VAS). Secondary endpoints were subjective and objective procedure time (SPT/OPT), heart rate, blood pressure, cortisol blood levels and scores in the State-Trait Anxiety Inventory (STAI) questionnaire. Results: Demographics of each group were similar (CG = mean age (a) = 69.5; ADG a = 67 years; AVDG a = 67). We did not find any significant difference regarding our primary endpoint, pain perception (p = 0.384). In contrast, we examined a highly significant difference between SPT and OPT, comparing AVDG to CG (p < 0.001) and AVDG to ADG (p < 0.001), but not for ADG to CG (p = 0.348). There was no significant difference in the secondary endpoints, heart rate, blood pressure, STAI scores and willingness to repeat the procedure. Conclusions: Our study shows that audiovisual distraction can significantly shorten SPT for patients receiving PPB, which may represent their comfort throughout the procedure. To accelerate the wider implementation of audiovisual distraction as a cost-efficient tool in outpatient urological procedures, further studies should examine its effect on different OPs with a more heterogeneous patient group. Full article

Under the dual constraints of limited resources and cold climate, the built environment of small cities in cold areas has a particularly prominent impact on the outdoor activities of the elderly and the need for aging optimization. Based on a questionnaire survey and field measurement data, combined with multiple linear regression, Spearman correlation analysis, and difference analysis, this paper systematically discusses the effects of different built environment characteristics on outdoor activity behaviors (frequency, intensity, and stay time) of the elderly in Bei’an City, Heilongjiang Province, China. The difference in environmental satisfaction of the elderly with different genders, ages, and education levels was analyzed. The results show that green coverage, air quality, leisure facilities, and barrier-free facilities are the core environmental factors that significantly improve the activity behavior of the elderly. In contrast, noise level, road damage, and inadequate facility maintenance significantly inhibit the activity willingness of the elderly. It was found that older adults are more dependent on barrier-free facilities and site safety, while younger people pay more attention to sports facilities and social space. Older women pay more attention to environmental details and cultural elements, while men tend to evaluate environmental functionality and so on. Further analysis shows that green environments and leisure facilities in cold climates provide visual beauty and play an important role in improving air quality and enhancing mental health. These elements are particularly critical in winter activities for older people, demonstrating the potential of the built environment to promote health and social participation. Starting from the unique background of small cities in cold regions, this study verified the applicability of the WHO age-friendly city framework in small cities in cold climates through empirical data, and revealed the necessity of climate-adaptive design (such as winter anti-slip facilities and cold-resistant greening) to improve the activity behavior of the elderly, providing a regional supplement to the existing theories. Full article

This study examines luxury tourists’ behavior toward sustainability in the aftermath of the pandemic, with a particular focus on the Maldives, a destination renowned for both its luxury offerings and commitment to sustainable practices. A qualitative approach was employed, featuring structured interviews with one hundred European tourists who had visited the Maldives and stayed at luxury resorts, alongside semi-structured interviews with three tour operator managers who sell the destination. In addition, secondary data provided by the tour operator were used to support the analysis and triangulate the data for more robust findings. The results show a significant shift in consumer attitudes: luxury travelers have become increasingly sensitive to sustainability and the protection of the environment since the pandemic. The tourists in the sample reported heightened awareness of their personal environmental impact and a greater desire to mitigate it. Furthermore, participants expressed a willingness to pay a premium for environmentally sustainable services and products, demonstrating a clear preference for businesses that can substantiate their eco-friendly practices through credible certifications and accreditations. These findings highlight the growing importance of sustainability in shaping luxury consumer behavior in the post-pandemic era. Full article

The proliferation of abandoned houses in rural South Korea poses significant challenges to sustainable rural development, driven by declining birth rates, aging populations, and urban migration. However, effective policy implementation is hindered by the lack of understanding of the negative externalities caused by abandoned houses. This study fills this gap by estimating the negative externalities associated with abandoned rural houses using discrete choice experiments. Surveys targeting individuals planning rural relocations and potential tourists considering rural stays were conducted to quantify the external costs. Our findings reveal that the marginal willingness to pay associated with abandoned houses is negative and decreases with an increasing number of abandoned houses nearby, both in the context of house purchases and rural stays. Extrapolating these results to the national level, we estimate the aggregate negative externalities value to be approximately 4.2 trillion KRW per year, highlighting significant negative externalities in rural areas nationwide. The implications of our analysis underscore the severity of negative externalities from abandoned houses, which may surpass the value of housing services, discourage migration, and prompt residents to leave rural communities, thus exacerbating the issue. Our study emphasizes the necessity for further research and policy interventions to address the negative externalities associated with abandoned rural houses, offering insights into the potential use of discrete choice experiments in similar contexts. Full article

The main objective of this research was to present Serbia as a destination for wellness and spa tourism, bearing in mind the fact that there are about 1000 springs in this area with a potential for tourism. Then again, since there are only about 40 active spas in Serbia, the aim of this paper is to show the positive aspects of the development of this form of tourism. For this, the example of good practice of the Bad Gastein Spa (Austria) was used, considering the similarities in the quality and medicinal properties of the water, which was analyzed and compared back in the 19th century. We wanted to use this example of good practice to show all the advantages of the development of wellness and spa tourism. A total of 462 respondents participated, of which 227 were residents of Sokobanja (Serbia), while 235 were from the Bad Gastein Spa (Austria). The authors surveyed the local population by staying in these spas, using a random sample system, and then compared the respondents’ answers. The results showed the positive impacts of the development of wellness and spa tourism in Austria, but also the willingness of the local population of Serbia to develop a modern spa concept related to wellness and spa tourism. It can be concluded that Sokobanja should position itself on the tourist market by creating its own identity through the development of wellness and spa tourism. Wellness and spa tourism in Serbia must be recognized as a priority sustainable form of tourism by decision makers at the highest level. The authors believe that the positive experiences of the development of wellness and spa tourism in Sokobanja will have a domino effect for the activation, transformation and development of all other potential spas in Serbia. Full article

A lack of options can make it challenging for individuals to find a desirable intimate partner. Conversely, an abundance of choices might lead to mate choice overload, making it difficult to determine the most suitable match. Additionally, having numerous alternatives after entering a relationship could undermine its stability by decreasing satisfaction with the current partner. The present research aimed to examine the effects of mate choice plurality on singlehood status and the willingness to stay in a relationship within the Greek cultural context. Specifically, we employed closed-ended questionnaires, which included instruments developed using AI, with a sample of 804 Greek-speaking participants. We found that participants who perceived they had a wider range of potential romantic partners reported a lower likelihood of being single. Furthermore, more perceived mate choices were associated with fewer years spent as single. However, mate choice plurality was also linked to higher choice overload, which, in turn, increased the likelihood of being single rather than in an intimate relationship. Moreover, more perceived mate choices were associated with more regrets about being in the current relationship. These regrets were linked to lower relationship satisfaction and ultimately contributed to a decreased willingness to stay in the relationship. Notably, this indirect effect was significant only for male participants. Full article