Nursing Reports doi: 10.3390/nursrep16050178

Authors: Matthias Pilz Lydia Sterzenbach Annabell Albertz

Background/Objectives: Skilled labor migration of nurses from low- and middle-income to high-income countries is a growing global phenomenon. While Germany increasingly recruits internationally trained nurses to address severe nursing shortages, existing research has predominantly focused on post-migration experiences, leaving the pre-migration phase unexplored. Drawing on the case of Kerala, India, this study examines the motives driving Indian nurses to migrate to Germany during the preparatory phase of migration. Methods: The qualitative study draws on individual and group interviews with 22 Indian nurses from Kerala participating in a pre-migration preparatory course. Data were analyzed using qualitative content analysis, with Herzberg’s two-factor theory serving as a theoretical lens. Results: In total, the findings demonstrate that nurses’ decisions to migrate to Germany are shaped by a complex and interrelated set of motives encompassing personal fulfillment, socio-cultural aspirations and professional development. The intrinsic motivation to engage with a new language and culture emerged as a particularly salient finding, representing a dimension frequently overlooked in existing research. Applying Herzberg’s theory, migration decisions appear to result from an interplay of intrinsic motivators like career advancement and the perceived absence of fundamental extrinsic conditions such as adequate salary and social security in the country of origin. Conclusions: The findings have practical implications for practitioners, policymakers, employers and training providers. Preparatory programs could extend beyond language and professional training to include cultural preparation and realistic expectation management, while integration measures in Germany could be tailored to the actual needs and motives of internationally recruited nurses.

Nursing Reports doi: 10.3390/nursrep16050177

Authors: Rasha Kadri Ibrahim Noor Hafiz Saleem Ruba Mohd Salameh Amal Abdullah Alali Bushra Ali Alnaqbi Ahmed Yahya Ayoub

Aim: This study aimed to evaluate self-reported digital health literacy levels and work engagement among nurses in the United Arab Emirates (UAE), while also examining associations with demographic factors and the interplay between digital health literacy and work engagement. Background: The integration of digital technologies into healthcare has transformed patient care, clinical practice, and administration. Nurses, as frontline practitioners, play a crucial role in utilizing digital tools to enhance patient interactions and navigate complex healthcare systems. Methods: Between May and August of 2024, 364 nurses in the United Arab Emirates participated in a cross-sectional design study. A standardized 21-item self-reported Digital Health Literacy questionnaire and a 9-item Utrecht Work Engagement Scale were administered. Descriptive statistics were used, with t-tests, ANOVA, correlations, and multiple linear regression applied. Results: The average score for self-reported digital health literacy (3.05 ± 0.57) and work engagement (4.83 ± 1.13) was high. Gender, age, work experience, and education level showed varying patterns of association with self-reported DHL and work engagement across total and subscale scores. Education level was significantly associated with self-reported DHL but not with work engagement. The overall work engagement score and its subscales were positively correlated with self-reported DHL. Conclusions: Our findings provide a robust basis for subsequent research on DHL and work engagement. These findings support the relevance of self-reported DHL as a factor associated with nurses’ work engagement in digitally intensive healthcare settings. The study reveals that nurses reported high levels of digital health literacy and work engagement.

Nursing Reports doi: 10.3390/nursrep16050176

Authors: Anne Kristin Snibsøer Christin Thompson Venke Klubben Prytz

Background: The flipped classroom is an innovative student-centered teaching approach frequently applied in nursing education. The success of the approach relies on students coming prepared to class. Faculties play a critical role in facilitating students’ pre-class preparation. Objective: The objective of this study was to elicit nursing students’ preferred designs for pre-class preparation in large-group, flipped-classroom teaching in evidence-based practice, and to use these insights to inform practical, faculty-driven changes to course design and delivery. Methods: An action research study was conducted among bachelor’s students in nursing at a Norwegian university college. Data were collected through questionnaires with closed and open-ended questions, focus group interviews, and class meetings. Descriptive statistics and thematic analysis were applied to analyze data. Data were analyzed sequentially, and findings provided guidance for further actions. Results: The action was carried out and evaluated in two cohorts. The thematic analysis revealed one main theme—students need motivation for pre-class preparation—and three associated sub-themes: (1) Information: Communicate relevance and provide timely reminders, (2) Organization: Learning platform and workload, and (3) Engage learners: Diverse, interactive and aligned learning activities. Conclusions: Faculties can support motivation through clear communication of relevance, a well-organized learning platform, activating pre-class activities, and timely reminders. Successfully accommodating pre-class preparation for large-group teaching also appears to require coordinated faculty engagement and a shared commitment to student-centered approaches. Further evaluation is needed to determine which specific configurations work best in different contexts.

Nursing Reports doi: 10.3390/nursrep16050175

Authors: Tina Košanski Marijana Neuberg Mateja Križaj Grabant Tomislav Meštrović

Background: Specialized palliative care requires nursing professionals to address the complex physical, psychological, social and spiritual needs of patients with advanced incurable illness. This study aimed to assess the perceived adequacy of formal educational preparation among nurses working in specialized palliative care services in the Republic of Croatia and examine its association with self-assessed knowledge and the perceived need for additional education. Methods: A nationwide cross-sectional survey was conducted among nursing professionals employed in specialized palliative care services across Croatia. Data were collected using a structured questionnaire assessing sociodemographic characteristics, perceived adequacy of formal education, self-assessed knowledge, as well as the need for additional education in physical, psychological, social and spiritual care domains. An Educational Sufficiency Discrepancy Index (ESDI) was calculated to quantify the difference between perceived educational sufficiency and continuing education needs. For inferential statistics significance was set at p < 0.05 (two-tailed). Results: Among the 194 nursing professionals who participated in the study, perceived educational sufficiency was highest in the physical domain (87.5%), where it exceeded the reported need for additional education (31.6%). Negative discrepancies were observed in social (−12.9) and spiritual care (−17.6), indicating perceived educational deficits. Representation of physical care content in formal education was significantly associated with higher self-assessed knowledge across several domains (physical p < 0.001; psychological p = 0.008; social p < 0.001; spiritual p = 0.008). No significant associations were found between self-assessed knowledge and age, work experience or level of education. Conclusions: Formal nursing education alone may not fully meet the multidimensional competency requirements of specialized palliative care practice. Strengthening structured continuing professional development, particularly in psychosocial and spiritual care, may support holistic palliative care delivery and sustained professional competence.

Nursing Reports doi: 10.3390/nursrep16050174

Authors: Hugo Rosado Patrícia Motta Ana Cruz-Ferreira Catarina Pereira

Background/Objectives: Dance-based programs have been shown to support psychological well-being in later life, yet evidence remains limited for dance-mediated psychomotor interventions. This study examined the effects of a 12-week creative-dance-mediated psychomotor intervention on life satisfaction and positive and negative affect in community-dwelling older adults. Methods: This 12-week non-randomized controlled trial involved 34 participants (74.6 ± 6.6 years), allocated by convenience to an experimental group (EG) or control group (CG). The EG participated in a creative-dance-mediated psychomotor intervention (3×/week; 60 min/session; 36 sessions), while the CG maintained usual daily activities. Life satisfaction was assessed using the Satisfaction With Life Scale (SWLS), and affective experience was assessed using the Positive and Negative Affect Schedule (PANAS) at baseline and post-intervention. Results: No adverse events occurred; attendance was 89.8%. Within-group comparisons showed significant improvements in the EG for SWLS (20.4%), PANAS positive affect (14.3%), and PANAS negative affect (−13.9%), p < 0.05. In the CG, a significant improvement was observed only for PANAS negative affect (−11.5%), p < 0.05. Post-intervention comparisons between groups revealed significant differences favoring the EG for SWLS (p = 0.018) and PANAS positive affect (p < 0.001), with no significant between-group differences at baseline. Conclusions: Over 12 weeks, the intervention was associated with higher life satisfaction and positive affect in the EG compared with the CG. These findings suggest that this intervention format is safe and feasible and may support psychological well-being in community-dwelling older adults.

Nursing Reports doi: 10.3390/nursrep16050173

Authors: Rui Novais Cláudia Rodrigues Fátima Braga Rui Pereira Carlos Sequeira Núria Albacar-Riobóo Silvana Martins Odete Araújo

Background: Population ageing has increased the number of older adults living in nursing homes, where loneliness and sleep disturbances are prevalent and negatively affect well-being. Evidence suggests a bidirectional relationship between loneliness and sleep quality, although research in institutionalised populations remains limited. Objectives: This study aimed to characterise the sociodemographic and health profile of nursing home residents in Northern Portugal and examine associations between sleep quality, loneliness, sociodemographic and health variables. Methods: A cross-sectional study was conducted with 157 older adults (≥65 years) across 13 nursing homes. Data were collected using a sociodemographic questionnaire and the Portuguese version of UCLA Loneliness Scale, Pittsburgh Sleep Quality Index and Montreal Cognitive Assessment. Pearson correlations and hierarchical multiple regression analyses were performed. Results: Participants were predominantly female (72.6%), widowed (55.4%), and aged ≥80 years. Most reported chronic conditions (98.7%) and limitations in activities of daily living (75.2%). Age showed modest positive correlations with loneliness. Loneliness dimensions were strongly associated with poorer sleep quality and greater daytime dysfunction. Hierarchical regression revealed that sociodemographic variables explained only a small proportion of variance in sleep quality. The addition of loneliness variables increased explained variance to 38.1%, highlighting loneliness as a key psychosocial predictor. Conclusions: Loneliness significantly influences sleep quality among older adults living in nursing homes. Interventions should integrate strategies to enhance social engagement alongside sleep hygiene measures. Longitudinal studies are recommended to clarify causal pathways.

Nursing Reports doi: 10.3390/nursrep16050172

Authors: Valentina Cerrone Rocco Capasso Marco Cascella Ivan Rubbi Anna Di Gisi Pierpaolo Di Santo Vincenzo Andretta

Background/Objectives: Caregiver burden is a relevant dimension of the caregiving experience among informal caregivers of cancer patients and is associated with psychological, physical, and social consequences. Although several instruments are available to assess the phenomenon, there is still limited consistency in the tools used across empirical oncology studies. Methods: A systematic review was conducted according to the PRISMA 2020 statement. A literature search was carried out in PubMed, Scopus, Web of Science, CINAHL, and PsycINFO up to February 2026. Quantitative studies assessing caregiver burden using standardized instruments in informal caregivers of adult cancer patients were included. Results: Thirteen studies met the eligibility criteria. The most frequently used instruments were the Zarit Burden Interview, followed by the Caregiver Burden Inventory. Less frequently used instruments included the Caregiver Reaction Assessment and the Caregiver Burden Scale. Most included studies relied on generic caregiver burden instruments originally developed outside oncology-specific contexts. Conclusions: Considerable heterogeneity exists in the instruments used to assess caregiver burden in oncology research. Empirical studies continue to rely predominantly on generic caregiver burden scales, while oncology-specific tools appear to be underused. Greater consistency in instrument selection may improve comparability across studies and support the integration of caregiver assessment into oncology practice.

Nursing Reports doi: 10.3390/nursrep16050171

Authors: Paola Guzmán-De Santa Ana Alexis Serna-Menor Ana Martínez-García Raquel Moreno-Sánchez Carlos Ruíz-Núñez Andrés Ignacio García-Notario Juan Pablo Hervás-Pérez Ivan Herrera-Peco

Introduction: Humanized care is a core indicator of nursing quality, yet its prevalence and determinants among Spanish undergraduates remain unclear. Methods: A cross-sectional survey was administered to fourth-year nursing students from public and private universities. Instruments included the Health Professional’s Humanization Scale (HUMAS), the Communication Styles Inventory-Revised (CSI-R) and a sociodemographic questionnaire that captured prior training: completion of ≥6 h role-playing seminars in patient–family communication. Results: Mean scores were 3.62 ± 0.48 for HUMAS and 2.50 ± 0.52 for CSI-R. Women exceeded men on HUMAS total (p = 0.025) and on Sociability, Emotional Understanding, Dispositional Optimism and Self-Efficacy (all p ≤ 0.013), but not on Affect-Regulation or CSI-R. Age correlated weakly with Optimism (r = 0.24) and Self-Efficacy (r = 0.21). Students who had completed the role-playing seminars recorded higher HUMAS totals (d = 0.50; p = 0.001) and sub-scores, with only a modest gain in Affect-Regulation, and showed a trend towards better CSI-R performance (p = 0.06). No differences emerged by university type. HUMAS and CSI-R correlated moderately (r = 0.32; p = 0.001). In multivariate analysis, training (β = 0.36; p = 0.001) and CSI-R (β = 0.26; p = 0.001) jointly explained 27.9% of humanization variance; male sex exerted a small negative effect (β = −0.19; p = 0.001), whereas age was nonsignificant. Conclusions: Structured communication seminars are a key factor associated with higher levels of humanization in senior nursing students, whereas sociodemographic influences are modest. Embedding longitudinal, simulation-rich modules in communication and emotional intelligence is therefore recommended to cultivate truly person-centered nurses and to narrow observed sex disparities.

Nursing Reports doi: 10.3390/nursrep16050170

Authors: Ziqiu Guo Tzu Tsun Luk Xue Weng Jung Jae Lee Yongda Wu Shengzhi Zhao Derek Yee Tak Cheung Agnes Yuen Kwan Lai Henry Sau Chai Tong Vienna Wai Yin Lai Tai Hing Lam Man Ping Wang

Objectives: To explore the experiences of ex-smokers acting as peer supporters delivering chat-based instant messaging smoking cessation support in a post- randomized controlled trial qualitative study. Methods: We used purposive sampling to recruit 21 ex-smokers, who had previously provided chat-based instant messaging behavioral support to smokers in Hong Kong. Individual online semi-structured interviews were conducted. All interviews were audiotaped and transcribed verbatim. The transcripts were analyzed using inductive thematic analysis following Braun and Clarke’s six-phase framework. Results: Five themes were identified: stepping into the supporter role as ex-smokers, contributions beyond facilitating smoking cessation, mutual benefits as ex-smoking peer supporters, challenges in providing support, and the potential of mobile health-based peer support. Participants identified experiential sharing as a key mechanism for engaging motivated smokers, although its impact was limited by low user responsiveness. They described extending their support beyond smoking cessation (e.g., stress relief and healthier lifestyles), and reported mutual benefits, such as enhanced happiness, a positive attitude, and prevention of smoking relapse. Nevertheless, participants’ ability to effectively support smoking was challenged by limited interaction in the mHealth setting, difficulties offering timely responses, and uncertainty about how to handle complex personal situations. They suggested that future mobile health peer support can consider involving famous people as peer supporters, using personalized messaging, and adding incentives in the program to increase smokers’ motivation. Conclusions: Ex-smoking peer support in mHealth settings appears feasible and mutually beneficial, but its effectiveness may be constrained by low engagement and unclear role expectations.

Nursing Reports doi: 10.3390/nursrep16050169

Authors: Marin Mamić Ivana Mamić Nikolina Farčić Robert Lovrić Ivana Barać Željko Mudri Marija Barišić Željka Dujmić Zrinka Puharić Ivan Vukoja

Introduction/Objective: Patient satisfaction with nursing care quality is an important patient-reported indicator of hospitalization experience. Previous studies have mainly examined sociodemographic, clinical, and organizational factors, while personality traits have rarely been included in explanatory models. This study examined the association of sociodemographic characteristics, hospitalization-related variables, and personality traits with patient satisfaction. Methods: A single-center cross-sectional study was conducted among hospitalized patients in a general hospital in Croatia. Data were collected at discharge using a demographic and hospitalization questionnaire, the NEO Five-Factor Inventory, and the Croatian version of the Patient Satisfaction with Nursing Care Quality Questionnaire. Group differences were analyzed using non-parametric tests, and hierarchical regression analysis was performed. Results: Younger age, employment, male gender, and better self-rated health were associated with higher satisfaction. Patients admitted on a scheduled basis and those staying alone or with one other person in the room were more satisfied. Sociodemographic variables explained 21.5% of the variance in satisfaction (R2 = 0.215; adjusted R2 = 0.168). After hospitalization-related variables were added, the explained variance increased to 30.1% (R2 = 0.301; adjusted R2 = 0.232). The addition of personality traits further increased the explained variance to 45.6% (R2 = 0.456; adjusted R2 = 0.385). In the final model, staying with two or more persons was negatively associated with satisfaction, whereas agreeableness and conscientiousness were positively associated with satisfaction. Conclusions: Patient satisfaction with nursing care quality was associated with patient characteristics, hospitalization conditions, and personality traits. Accommodation conditions and individual psychological differences should be considered when interpreting satisfaction as an indicator of nursing care quality.

Nursing Reports doi: 10.3390/nursrep16050168

Authors: Lucília Nunes Andreia Ferreri Cerqueira Ana Poeira

The organized integration of research competencies into nursing curricula is still a global challenge and is key for preparing professionals to respond to complex clinical contexts, technological advancements, and contemporary societal demands. At the School of Health of the Polytechnic Institute of Setúbal, a longitudinal research axis was implemented across the four years of the undergraduate nursing program, involving epistemological foundations, the research process, evidence-based practice, and applied practice. Objective: The objective of this study was to describe the design and implementation of the longitudinal axis of research, analyzing institutional indicators of academic success and the progressive development of students’ scientific competencies. Methods: A descriptive documentary study based on institutional data analysis (the number of enrolled students, pass rates, and mean grades in the four research-related curricular units) was conducted, complemented by a review of pedagogical materials produced (two published course booklets: “Research I—From the origin to the dissemination of knowledge” and “Research II—(De)Constructing the Research Process: A Critical and Practical Analysis”) and evidence of scientific dissemination (conference presentations and published articles). Results: A continuous progression in academic performance was observed across the research curricular units, accompanied by increased complexity of student work and enhanced scientific literacy. The sequential structure proved essential: the articulation of epistemology, methodology, critical appraisal, and scientific production demonstrated strong coherence and pedagogical efficiency. Conclusions: The longitudinal research axis constitutes a curricular innovation that strengthens essential scientific competencies in undergraduate nursing education. Longitudinal models that reflect both conceptual and practical progression can significantly contribute to the development of nurses who are critical thinkers, reflective practitioners, and capable of integrating evidence into clinical decision-making.

Nursing Reports doi: 10.3390/nursrep16050167

Authors: Samantha Ruth Novales-Huidobro Maria Lorena Ángeles-Pacheco Misato González-Kawahara Natalia Constantino-Segura Paula García-Olea Reyna Sámano Gabriela Chico-Barba

Background: Violence in healthcare settings affects nursing students during clinical training and may compromise their mental well-being, learning experiences, and professional development. Despite evidence from high-income countries, limited data exist on how contextual and organizational factors in Latin American settings shape these experiences. This study aimed to assess the frequency and types of violence experienced by nursing students during clinical practice and the academic and emotional consequences. Methods: Cross-sectional study conducted among undergraduate and graduate nursing students in Mexico City who had completed at least one hospital-based clinical placement in the previous 12 months. Data were collected between January 2024 and September 2025 using a validated questionnaire assessing types of violence, perpetrators, academic and emotional consequences. Violence was defined as experiencing events “occasionally,” “sometimes,” or “frequently.” Descriptive statistics were calculated. Associations were examined using Pearson’s chi-square test, and logistic regression models adjusted for age, sex, and year of study. Results: Seventy-three students participated (86.3% female). Non-physical violence was the most frequent type (90.4%), followed by sexual harassment (49.3%), mainly perpetrated by nurses (62%) and physicians (46.5%). Considering leaving the profession (41.4%) and feelings of inadequacy (66.2%) were the most common academic and emotional consequences. Although some associations were observed in bivariate analyses, these were not significant after adjustment. Conclusions: Violence during clinical training is highly prevalent and may represent a significant threat to nursing students’ mental well-being and professional development. Strengthening institutional policies, reporting mechanisms, and supportive learning environments is essential to mitigate its impact and promote safer clinical training.

Nursing Reports doi: 10.3390/nursrep16050166

Authors: Mario Marendić Ajka Pribisalić Ivana Bokan Ivana Parčina Silvija Vladislavić Mario Podrug Ante Buljubašić Anamarija Jurčev Savičević

Background: Nursing students are at high risk of exposure to blood and body fluids due to limited clinical experience. Ensuring adequate knowledge and proper post-exposure protocols is vital for improving safety and post-exposure management. Aim: This study aimed to evaluate the level of knowledge, previous exposure experience, and reporting practices regarding occupational exposure incidents among nursing students at the Faculty of Health Sciences, University of Split, Croatia. Methods: A cross-sectional study was conducted among 274 nursing students using a structured self-administered questionnaire. Descriptive statistical methods were applied, along with univariate and multivariate linear regression analyses. Results: Exposure incidents were experienced by 36.3% of students, with needlestick injuries being the most common (80.1%). In terms of reporting practices, fewer than half (40.8%) of those affected officially reported the incident. While students demonstrated adequate overall performance on the knowledge assessment (median score 12, IQR: 11–14), significant gaps were identified in hepatitis B and C protocols and immediate wound care. Multivariate analysis identified full-time student status (β = 1.24; p = 0.010) and first-year students (β = 0.82; p = 0.036) as factors significantly associated with higher knowledge scores. Conclusions: Although nursing students possess solid fundamental knowledge of exposure-related risks, a significant gap remains in their practical application and incident reporting. The high incidence of needlestick injuries (80.1%) underscores the importance of moving beyond theory toward enhanced clinical supervision. To address these gaps, nursing education should prioritize targeted practical training and cultivate a robust safety culture that encourages incident reporting.

Nursing Reports doi: 10.3390/nursrep16050165

Authors: Carlo Alberto Camuccio Paola Tiatto Orejeta Diamanti Elisabetta Bisinella Rachele Loro Alice Bernardi Martina Berto Federica Turchet Andrea Rostirolla Elena Reginato Shabnam Zohrabi Weisha Qi Matteo Bernardi

Background/Objectives: The placement of central venous access devices, including peripherally inserted central catheters (PICCs) and PICC-PORTs, is a routine procedure in oncology care. Usually associated with limited physical pain, these procedures may nevertheless generate significant anxiety and negatively influence the overall procedural experience. Virtual reality (VR) has emerged as a non-pharmacological intervention capable of modulating attentional and emotional responses during medical procedures; however, evidence in adult oncology patients undergoing vascular access placement remains scarce. The aim of this study is to evaluate the effect of VR on an oncological patient’s overall procedural experience. Methods: This manuscript outlines the design and methodology of a prospective, single-centre randomised controlled trial. Adult oncology patients scheduled for PICC/PICC-PORT placement are randomised to receive standard care alone or standard care combined with an immersive VR intervention delivered via a head-mounted display during the procedure under pragmatic, real-world clinical conditions. The primary outcome is a composite patient-reported procedural experience endpoint, assessed through a non-aggregated framework encompassing procedural anxiety, comfort, satisfaction and procedural tolerability. Procedural anxiety constitutes the main quantitative driver; the remaining domains are analysed as individual component dimensions and interpreted jointly to contextualise the overall experience. Secondary outcomes include procedural pain, physiological parameters and procedural characteristics. A mixed-methods approach integrates quantitative assessment with qualitative phenomenological analysis. Results: The study is expected to provide methodological and clinical insight into the role of immersive VR in improving procedural experience and support future multicentre trials. Conclusions: This trial will contribute to the expanding field of digital and immersive health technologies by evaluating VR as a patient-centred adjunct intervention in oncological procedural care using a predefined patient-reported experience-based primary endpoint. The protocol has been submitted to ClinicalTrials.gov with the registration number NCT07384741.

Nursing Reports doi: 10.3390/nursrep16050164

Authors: Olinda Monsanto António Nunes Ana João

Background: Nurses’ job satisfaction is an important factor associated with motivation, retention, and performance, potentially influencing the quality and safety of healthcare delivery. Identifying organizational and professional determinants of job satisfaction is essential for the sustainability of healthcare systems. Objective: This study aims to describe nurses’ job satisfaction across its multiple dimensions and examine differences in job satisfaction dimensions across sociodemographic and professional groups. Methods: A quantitative, cross-sectional, descriptive–correlational study was conducted with 153 nurses. Data were collected between October and December 2024 using an online questionnaire, with a response rate of 28.9%, which included the Escala de Satisfação dos Enfermeiros com o Trabalho (ESET). Descriptive and inferential statistical analyses were performed, with the significance level set at 0.05. Results: Moderate levels of job satisfaction predominated among participants (75.8%), with 5.2% of participants reporting low satisfaction. The highest mean scores were observed in satisfaction with co-workers and professional recognition, while the lowest scores were found in the recognition and remuneration dimension. Statistically significant differences in mean job satisfaction scores were observed across groups defined by variables such as work setting, work schedule, weekly workload, and employment across multiple workplaces. Conclusions: Nurses’ job satisfaction is multidimensional and varies across different professional and organizational groups. These findings highlight areas of lower job satisfaction that may represent priorities for future organizational assessment and management attention.

Nursing Reports doi: 10.3390/nursrep16050163

Authors: Marcello Torre Cristina Arrigoni Rosario Caruso Antonio Maria Giuseppe Staffa Desiree Lucà Arianna Magon

Background/Objectives: Nurse transition programmes are widely implemented to support newly hired nurses and promote workforce retention. Despite the growing number of published reviews, conceptual inconsistency and methodological heterogeneity limit the interpretability and cumulative value of the evidence. This umbrella review aimed to synthesise and critically examine review-level evidence on nurse transition programmes, clarifying programme typologies, contexts, methodological approaches, reported outcomes, and thematic patterns. Methods: An umbrella review was conducted in accordance with PRISMA 2020 guidance. Systematic searches were performed in CINAHL, PubMed, Scopus, Web of Science, and Google Scholar, supplemented by citation tracking. Results: Fourteen reviews published between 2010 and 2025 were included: 12 reviews of primary studies and two reviews of secondary evidence (one umbrella review and one meta-review). Programme models and outcome measures were highly heterogeneous, and primary study overlap was slight (CCA = 2.55), indicating that reviews in the corpus drew on largely non-overlapping sets of primary studies. Transition programmes for new nurses commonly use one-on-one preceptorships with supernumerary practice, simulation-based learning, and active methods like case studies and reflective journaling to build competence and confidence. Their duration varies from a few days to 12 months, aligning with the progressive learning curve of new graduates. Professional outcomes, particularly competence and confidence, were consistently reported, whereas organisational outcomes, such as retention, showed mixed, methodologically constrained evidence. Patient-level outcomes were rarely examined. Thematic analysis revealed a shift over time from individual professional readiness towards implementation and organisational considerations. Conclusions: Given this conceptual plurality, there is an urgent need to standardise key indicators for evaluating the effectiveness of nurse transition programmes across healthcare settings globally.

Nursing Reports doi: 10.3390/nursrep16050162

Authors: Petra Zuborova Alica Slamkova Milos Mlyncek Jozef Visnovsky Jan Bujnak Pavol Zubor

Objectives: This study sought to assess quality of life (QoL) in Slovak breast cancer survivors and examine its association with treatment modalities and sociodemographic factors. Methods: This cross-sectional observational study included 244 Slovak female breast cancer survivors (stages IA–IIIC). Participants were aged 25–85 years, ECOG 1–2, without synchronous malignancies or severe comorbidities. Data were collected using the EORTC QLQ-C30 and breast cancer-specific module. Results: Mean global health status/QoL indicated a moderate QoL level (51.67). Emotional and cognitive functioning were relatively preserved, whereas social and role functioning were more impaired. The most prominent symptoms included insomnia, fatigue, dyspnoea, and pain. Breast cancer-specific domains showed relatively high body image scores but marked impairment in sexual activity and future perspective. Severe symptoms included hair loss, upper limb problems and systemic side effects of therapy. Significant differences were observed across functional domains and symptoms (p < 0.001). Chemotherapy was associated with better role functioning (p = 0.011), lower pain (p = 0.043) and insomnia (p = 0.012), but also with higher levels of hair loss (p = 0.003); however, these findings should be interpreted with caution due to potential confounding factors. Radiotherapy was associated with higher social functioning, body image and future perspective (p = 0.007 for all), but also with increased breast symptom severity (p = 0.044). Sociodemographic factors, particularly place of residence and education level, were significantly associated with overall QoL. Conclusions: Slovak breast cancer survivors report moderate overall QoL, with emotional and cognitive functioning relatively preserved, but social, role and sexual domains impaired. Treatment modalities and sociodemographic factors are associated with differences in specific QoL domains, highlighting the need for targeted, context-sensitive supportive care. The findings also underscore the importance of oncology nursing in survivorship care, particularly in addressing physical, social and sexual domains and key symptoms such as insomnia, fatigue and pain. Targeted psychosocial and educational support, along with culturally sensitive QoL assessment, may help improve patient-centred outcomes in breast cancer survivors in Central and Eastern Europe.

Nursing Reports doi: 10.3390/nursrep16050161

Authors: Blerina Duka Kejda Nuhu Fabiola Mane Jola Çini Armela Zylfo Kujtime Vakeflliu Alta Arapi

Background/Objectives: The rapid expansion of telemedicine has reshaped healthcare delivery, positioning telenursing as essential for continuity of care and patient management. This scoping review maps current evidence on telecare nursing practices, examining organizational models, professional roles, and key clinical and organizational outcomes. Methods: The review was conducted across five international databases, following the methodological framework proposed by Arksey and O’Malley, the interpretive extension by Levac et al., and the Joanna Briggs Institute guidelines, with reporting aligned to PRISMA-ScR recommendations. The search identified 1760 records, of which 1219 remained after duplicate removal. After title and abstract screening and full-text evaluation, 25 studies met the inclusion criteria. Results: Telenursing was implemented across diverse clinical contexts, particularly in chronic disease management, oncology, postoperative care, and emergency settings. Evidence indicates improvements in symptom management, therapeutic adherence, quality of life, and complication reduction, suggesting positive clinical and organizational impacts. The literature highlights the need for advanced digital, communication, and relational competencies, emphasizing the importance of targeted professional training. Cross-cutting trends include enhanced continuity of care, greater patient autonomy, improved integration between hospital and community services, and reduced healthcare costs. Conclusions: This review provides an updated overview of telenursing applications, highlighting their adaptability across clinical settings and the expanding strategic role of nurses in digital care. The findings indicate a rapidly evolving field and emphasize the need for further research to strengthen organizational frameworks, define advanced competencies, and support the sustainable integration of telenursing into healthcare systems.

Nursing Reports doi: 10.3390/nursrep16050160

Authors: Amelina de Brito Belchior Victória Maria Silva Leitão Thiago Martins de Sousa Lourival Veras de Oliveira Pablo Casimiro Belchior Rodrigues Florencia Gamileira Nascimento Sherida Karanini Paz de Oliveira

Objective: To test the factorial structure and reliability of the Brazilian version of the Diabetic Foot Self-Care Questionnaire of the University of Malaga-Spain (DFSQ-UMA-Br). Method: Cross-sectional study for psychometric evaluation of the DFSQ-UMA-Br conducted with 269 people with diabetes who responded to the items of the collection instrument composed of sociodemographic and clinical data and the tested instrument, from February 2024 to February 2025. The internal structure was evaluated using Exploratory and Confirmatory Factor Analysis. Reliability was assessed using Cronbach’s alpha and McDonald’s omega. Results: The factor analysis for the DFSQ-UMA-Br data matrix was adequate (KMO = 0.79 [95% CI] = 0.71–0.82]); Bartlett’s sphericity test = p < 0.001; degree of freedom of 66), indicating that the variables are correlated. Psychometric sensitivity with adequate values of asymmetry (sk = 0.199–3.655) and kurtosis (ku = −0.226–+3.764) proving the normal distribution of data. Conclusions: The DFSQ-UMA-Br is a valid and reliable instrument capable of assessing foot self-care in people with diabetes in the Brazilian population and can be used by nurses and other professionals to promote health in the context of clinical care and research.

Nursing Reports doi: 10.3390/nursrep16050159

Authors: Thaynara Helena Ribeiro e Silva Medeiros José de Ribamar Medeiros Lima Junior Conceição de Maria Pedrozo e Silva de Azevedo Larissa Di Leo Nogueira Costa Marisa Cristina Aranha Batista Francyelle Costa Moraes Rachel Melo Ribeiro Almir José Guimarães Gouveia Ana Hélia de Lima Sardinha Fernanda Costa Rosa Mayara Soares Cunha Leonel Lucas Smith de Mesquita Luciana Batalha Sena Sara Fiterman Lima Angela Falcai

Objective: To identify the predictors of weight gain in people living with HIV (PLHIV) using antiretroviral therapy (ART). Methods: Observational, analytical, cross-sectional study with a quantitative approach, with 186 participants followed up at a specialized HIV service. Sociodemographic, behavioral, clinical, and anthropometric data were collected. Associations between overweight and independent variables were assessed using chi-square and logistic regression analyses, adopting a significance level of p < 0.05. Results: Most participants were male (62.5%), aged between 40 and 49 years (33.2%). Overweight was prevalent in 70% of the sample, predominantly affecting males, sedentary individuals, and those with diabetes mellitus. There was a statistically significant association between overweight and age (p = 0.047), as well as with a diagnosis of diabetes (p = 0.029). Despite the high rate of viral suppression (97.3%), there was a prevalence of metabolic alterations, such as dyslipidemia and sedentary lifestyle. Conclusions: Weight gain in PLHIV in ART is associated with metabolic factors and age. The strategic role of health professionals in monitoring BMI, health education, and preventing unfavorable clinical outcomes, such as diabetes and cardiovascular diseases, is highlighted.

Nursing Reports doi: 10.3390/nursrep16050158

Authors: Eva M. Montoro-Ramírez Isabel M. López-Medina Daniel Puente-Fernández Laura Parra-Anguita

Introduction: Climate change is increasingly affecting the health of older people. This study aimed to determine the knowledge, skills, and attitudes of nurses and undergraduate nursing students regarding the effects of climate change on older people’s health. Material and Methods: A descriptive cross-sectional study was conducted between January and April 2024 with 708 participants (210 nurses and 498 undergraduate nursing students). The Nursing Competencies Questionnaire on Environmental Health of Older People (NCQ-OPEH) was used to assess environmental competencies. Descriptive values were calculated and interrelationships between knowledge, attitudes, and skills were analysed. Results: A total of 115 nurses (54.75%) and 185 students (37.15%) demonstrated good-excellent knowledge. Similarly, a higher percentage of nurses (50.77%) reported better perceived skills than students (42.52%). However, the majority of both samples (98.97% and 87.85%, respectively) had good to excellent attitudes. These differences were significant for knowledge (p < 0.001) and attitudes (p = 0.013) but not for skills (p = 0.054). Furthermore, a significant relationship was found between prior education on climate change and health and greater knowledge (p = 0.019) and skills (p = 0.027) among nurses and better skills and attitudes (p < 0.001 in both) among nursing students. Conclusions: Nurses have better environmental competencies than undergraduate nursing students. Therefore, it is important to include education on climate change and older people’s health to be included in the academic curriculum of university nursing degrees. Nurses also need to reinforce these competencies through specific educational programmes, ensuring that clinical practice effectively adopts an environmental health approach to the care of older people.

Nursing Reports doi: 10.3390/nursrep16050157

Authors: Mary Rose Arcedo Julie Flynn Daniel Terry

Background/Objectives: Anaesthetic nurses play a critical role during surgical procedures. However, research focusing on Australian anaesthetic nurses remains limited. While previous studies have identified inconsistencies in anaesthetic nurse education, the everyday experiences of these nurses have not been comprehensively examined. This study aimed to explore the barriers and enablers influencing anaesthetic nursing practice in Australia and to examine anaesthetic nurses’ views on their evolving roles and responsibilities. Methods: A hermeneutic phenomenological approach was employed to explore the lived experiences of Australian anaesthetic nurses. Semi-structured interviews were undertaken to enable in-depth exploration of participants’ experiences, thoughts, feelings, and beliefs. Participants were interviewed by telephone, videoconference, or in person. Data were transcribed verbatim into Microsoft Word and analysed using reflexive thematic analysis, informed by Gadamerian hermeneutics. Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines were followed. Results: Four overarching themes were identified, Culture, Education, Leadership, and Institution, each shaping anaesthetic nursing practice in distinct yet interrelated ways, with several subthemes emerging within each category. These interrelated factors contributed to perceptions of being undervalued, restricted career progression, and uncertainty regarding role sustainability. Conclusions: The findings highlight the need for enhanced support systems and system-level reform that addresses hierarchical power dynamics alongside standardised, context-specific education and training pathways. Addressing these interconnected issues is essential to better support anaesthetic nurses while ensuring competent, high-quality care is provided. Understanding the structural and cultural concerns underpinning anaesthetic nursing practice may inform the development of coherent curricula, visible nursing leadership, and clearer professional recognition and career pathways.

Nursing Reports doi: 10.3390/nursrep16050156

Authors: María José Ferreira Ana Laguía Gabriela Topa

Background/Objectives: Therapeutic communication is a core competency in mental health nursing, yet clinical placements often offer limited opportunities for undergraduate students to practise relational skills in a safe and structured way. Simulation, particularly when aligned with the Healthcare Simulation Standards of Best Practice™ (INACSL), may provide a useful context for fostering empathy, emotional presence, and professional communication. This study aimed to evaluate undergraduate nursing students’ satisfaction and self-confidence following participation in a standardised-patient simulation designed to address therapeutic relationship competencies. Methods: A descriptive cross-sectional study was conducted with 142 third-year nursing students at a public university. Participants completed two INACSL-aligned simulation encounters involving psychiatric scenarios that required therapeutic engagement. After the sessions, students completed a questionnaire based on the Student Satisfaction and Self-Confidence in Learning Scale, adapted to the context of the simulation. Data were analysed using descriptive statistics. Results: Students reported high levels of satisfaction and self-confidence following the simulation experience. Between 88.0% and 92.9% of participants agreed or strongly agreed with items related to realism, relevance, and motivation. High levels of agreement were also observed for items related to therapeutic communication, critical thinking (98.6%), clinical competence (95.8%), and teamwork (93.6%). Lower levels of agreement were found for the usefulness of video-based debriefing (61.9%) and the adequacy of material resources (57.1%), suggesting areas for improvement in future implementation. Conclusions: Standardised-patient simulation was positively evaluated by nursing students and was associated with high levels of satisfaction and self-confidence in learning. The findings suggest that this type of educational strategy may support students’ perceived development of therapeutic communication and relational skills in mental health nursing education. However, these results are based on self-reported data collected using an adapted measurement approach and should be interpreted with caution. Further research using validated instruments and performance-based measures is needed to assess competence development more directly.

Nursing Reports doi: 10.3390/nursrep16050155

Authors: Ali Ay Hülya Bulut

Background/Objectives: Peristomal skin complications are common among individuals with a stoma and are associated with decreased quality of life, increased healthcare costs, social isolation, and various other challenges. However, these complications can often be prevented through appropriate care, patient education, counseling, and follow-up. This quasi-experimental study aimed to evaluate the effectiveness of education based on Orem’s Self-Care Deficit Nursing Theory (SCDNT) in preventing peristomal skin complications. Methods: The study included 45 patients with newly formed stomas, allocated to an experimental group (n = 24) and a control group (n = 21) using a nonrandomized approach. Both groups received routine postoperative education, while the experimental group additionally received structured education, counseling, and follow-up based on SCDNT. Data were collected using the Patient Characteristics Form, Self-Care Agency Scale (SCAS), Stoma Quality of Life Scale (SQOL), Patient Outcomes Evaluation Form, and Patient Opinions Questionnaire. Results: Among the participants, 73.3% had undergone stoma surgery due to cancer, and 53.3% had an ileostomy. Peristomal skin complications were observed in 54.2% of patients in the experimental group and 95.2% in the control group (p < 0.05). The most frequently reported complications were irritant dermatitis (71.4%) and hyperplasia (22.7%). The mean recovery time was shorter in the experimental group (21 ± 12.95 days) compared to the control group (44.65 ± 23.56 days) (p < 0.05). Conclusions: SCDNT-based education, counseling, and follow-up may be associated with lower rates and shorter durations of peristomal skin complications and earlier patient engagement in self-care. However, these findings should be interpreted with caution due to the nonrandomized design, small sample size, and differences in follow-up intensity. Further randomized controlled studies are recommended to confirm these findings.

Nursing Reports doi: 10.3390/nursrep16050154

Authors: Awatif Alrasheeday Aeshah Abdulaziz ALhawsawi Bushra Alshammari Sameer A. Alkubati Wiem Aouicha Mohamed Ayoub Tlili Abdulhafith Alharbi Bahia Galal Siam Soha Mahmoud Badria Elamin Layla Alshammari Hajer I. Motakef Tahani Alkhammali Ahad Alanazi Fatimah Alshammari Huda Alshammari Ruqayyah Abdullah Almohammed Ruba Abdulaziz Alomran

Background/Objectives: Artificial intelligence (AI) is increasingly used in healthcare to support clinical decision-making, patient monitoring, and administrative tasks. Nurses are expected to work with these technologies. However, the evidence suggests that their knowledge and preparedness remain limited. As future healthcare providers, nursing students must be prepared to integrate AI into their practice. This study aimed to assess nursing students’ knowledge, attitudes, perceived benefits and risks, barriers, professional impact, and preparedness toward AI in healthcare. Methods: This cross-sectional descriptive study was conducted between April and July 2024 at the College of Nursing, University of Hail, Saudi Arabia. A convenience sample of 320 undergraduate nursing students completed an online structured questionnaire that assessed their demographics, knowledge, attitudes, perceived barriers, benefits, risks, professional impact, and preparedness. Data were analyzed using IBM SPSS version 27 with descriptive statistics. Inferential analyses, including independent t-tests and one-way ANOVA, were performed to examine differences between groups. Pearson’s correlation was used to identify correlations between the study variables. Statistical significance was set at p < 0.05. Results: Most students (79.7%) had poor AI knowledge, whereas 52.5% reported positive attitudes. Older students (≥24 years) and internship students showed significantly more positive attitudes (p < 0.001). Knowledge was weakly correlated with attitudes (r = 0.147), benefits (r = 0.222), and risks (r = 0.152). Attitudes were weakly positively correlated with benefits (r = 0.243) and negatively correlated with barriers (r = −0.219). Conclusions: Despite their positive attitudes, nursing students showed limited knowledge and preparedness. Integrating AI education and practical training into nursing curricula is therefore essential. These findings should be interpreted cautiously given the cross-sectional design, single-institution sampling, and reliance on self-reported measures, which may limit generalizability.

Nursing Reports doi: 10.3390/nursrep16050153

Authors: Misuzu Gregg Chifuyu Hayashi Masami Tamada

Background/Objectives: Effective information seeking is essential for new graduate nurses’ adaptation to the workplace. The objective of this study was to identify how nurse managers and senior nurses support new graduate nurses’ information seeking and the expectations underlying such support. Methods: Nurse managers and senior nurses from Japanese hospitals participated in semi-structured interviews. Data were analyzed using qualitative content analysis by coding meaningful units, grouping similar codes into subcategories, and organizing them into broader categories. Ethical approval was obtained from the research ethics committee of the first author’s institution, and written informed consent was obtained from all participants. Results: Participants included twelve nurse managers from five hospitals and fourteen senior nurses from three hospitals. The nurse managers had an average of 7.4 years of supervisory experience, and the senior nurses had an average of 14.2 years of clinical experience. Participants expected new graduate nurses to demonstrate appropriate attitudes toward seeking information, engage in proactive communication to express their needs or uncertainties, take initiative in seeking and obtaining information, and build relationships with senior nurses that would facilitate information seeking. To support these expectations, participants adopted approaches that encouraged information seeking, proactively provided necessary information, and promoted information sharing among peers. Nurse managers also sought to create a work environment in which all staff members collectively nurtured new graduate nurses. Conclusions: To facilitate information seeking among new graduate nurses, nurse managers and senior nurses need to foster a supportive work environment. They also need to recognize the information content, sources, tactics, and timing appropriate for new graduate nurses.

Nursing Reports doi: 10.3390/nursrep16050152

Authors: Leila Sales Maria Ferreira Raquel Pereira Isabel Lucas Rita Marques Inês Bento

Simulation is increasingly recognised as a strategic approach in nursing education for developing clinical competencies within safe learning environments. However, there is limited understanding of how virtual patient simulation supports the early development of clinical reasoning from the perspective of nursing students. Aim: To explore the perceptions of first-year undergraduate nursing students regarding the development of clinical reasoning and collaborative decision-making through virtual patient simulation. Methods: A qualitative, descriptive, and exploratory design was adopted. Semi-structured focus groups were conducted with 73 first-year undergraduate nursing students. Data were analysed using thematic content analysis following Bardin’s approach. Results: Students perceived virtual patient simulation as a meaningful and high-impact learning strategy. Realism, interactivity, and group collaboration emerged as key strengths. Engagement with dynamic clinical scenarios supported the integration of theoretical knowledge into practice, enhanced prioritisation skills, and promoted structured clinical reasoning. Collaborative learning facilitated shared reflection and collective problem-solving, while immediate feedback enabled learning through error within a psychologically safe environment. Participants also reported increased confidence and autonomy in decision-making. At the same time, students identified limitations related to software constraints and the alignment between automated assessment and their reasoning processes. Conclusions: Group-based virtual simulation appears to support the early structuring of clinical reasoning, extending beyond technical skill acquisition to foster reflective and collaborative practice. Its educational value, however, depends on intentional curricular integration and strong pedagogical alignment including structured facilitation, alignment between assessment and learning objectives, and opportunities for guided reflection. These findings contribute to a process-oriented understanding of how novice learners make sense of clinical reasoning in simulated contexts.

Nursing Reports doi: 10.3390/nursrep16050151

Authors: Huina Zou Linjing Wu Kaixin Li Polun Chang Yuan Chen

Background/Objectives: Nursing informatics competency is critical for nursing students entering clinical practice in the digital era. Current undergraduate nursing informatics courses prioritize theoretical instruction but lack sufficient integration with clinical applications, which restricts the depth of content delivery. This study aimed to design, implement, and conduct a preliminary evaluation of an undergraduate nursing informatics literacy course. Methods: This was a single-arm mixed-methods study. We implemented five sequential steps aligned with the Analysis, Design, Development, Implementation, and Evaluation (ADDIE) model: (1) needs assessment, (2) design of a systematic, progressive course spanning theoretical foundation, technical skills, and clinical application; (3) development of teaching materials and environment; (4) implementation through nine weekly 90 min sessions incorporating teach–practice–feedback; and (5) evaluation via a customized questionnaire and nursing informatics system project reports. Quantitative data were analyzed using the mean, standard deviation, and paired t tests; qualitative data were collected through post-course semi-structured interviews. Results: A total of 120 participants were enrolled from a provincial public medical school, of which 119 (99.2%) completed the course. Statistically significant pre–post improvements were observed in participants’ nursing informatics competencies, informatics literacy self-efficacy, and innovative behavior after course completion (p < 0.001). Participants completed 12 group projects, which received two C grades, nine B grades, and one A grade. Overall course satisfaction averaged 89.03 ± 14.62. Qualitative interviews yielded three themes: (a) cognitive reconstruction and improvement in the ability to apply nursing informatics competencies, (b) dilemmas and breakthroughs in the integration of technology and knowledge in nursing informatics design, and (c) optimization direction of course content, design, and evaluation. Conclusions: An ADDIE-based nursing informatics literacy course may be associated with improvements in nursing informatics competencies, informatics literacy self-efficacy, and innovative behavior among nursing undergraduates. This study provides preliminary evidence supporting the feasibility and potential educational value of such a curriculum.

Nursing Reports doi: 10.3390/nursrep16050150

Authors: Itziar Hoyos Cillero Iñigo Lorenzo Ruiz

Background/Objectives: Limited research has examined the correlates among the lifestyle habits of nursing students, whose suboptimal behaviors may compromise their ability to model and promote healthy lifestyles in future professional practice. This study aimed to assess health-promoting lifestyle behaviors, explore interrelationships among lifestyle domains, and identify key correlates of positive health-promoting lifestyle behaviors to inform the development of targeted interventions. Methods: A cross-sectional study was conducted among 476 undergraduate nursing students in Spain. Data included sociodemographic, academic, and health-related variables, along with Health-Promoting Lifestyle Profile II (HPLP-II) scores. Descriptive statistics, correlations, and hierarchical multivariate logistic regression were used to identify factors associated with positive health-promoting lifestyle behaviors. Results: Overall HPLP-II scores indicated modest health-promoting lifestyle behaviors (adjusted mean 2.62 ± 0.33), with the lowest scores observed for health responsibility (adjusted mean 2.20 ± 0.48) and stress management (adjusted mean 2.33 ± 0.44). Health-related variables showed stronger associations with positive health-promoting lifestyle behaviors than sociodemographic or academic variables (p < 0.001). Significant correlates of positive health-promoting lifestyle behaviors included higher adherence to the Mediterranean diet, greater levels of physical activity, and concurrent employment during studies. Conclusions: Support of nutrition, physical activity, and other health-promoting lifestyle behaviors should be strengthened in nursing curricula and training environments. Educational strategies should move beyond theoretical instruction through student-centered approaches, enhancing self-care and the ability to promote health in future professional practice.

Nursing Reports doi: 10.3390/nursrep16050149

Authors: Verónica Pérez-Muñoz Antonio Jesús Ramos-Morcillo Alonso Molina-Rodríguez María Ruzafa-Martínez

Background: Evidence-based practice (EBP) is a cornerstone of high-quality and safe nursing care. However, undergraduate nursing students often experience cognitive, methodological, and contextual barriers to learning and applying EBP. Active teaching strategies, such as the flipped classroom, may support the development of EBP competencies, yet qualitative evidence exploring students’ learning experiences remains limited. Objectives: To explore nursing students’ perceptions and experiences of learning evidence-based practice through a flipped classroom model. Methods: A qualitative descriptive study was conducted at the Faculty of Nursing of the University of Murcia (Spain). Purposeful maximum variation sampling was used to recruit undergraduate nursing students from the second and fourth academic years who had completed an EBP course delivered using a flipped classroom approach supported by an online learning platform. Twenty semi-structured interviews were conducted via videoconference. Data were transcribed verbatim and analyzed using reflexive thematic analysis with independent coding by two researchers and consensus procedures. Ethical approval and confidentiality were ensured. Results: Three main themes were identified: (1) transformation of the meaning of EBP learning and professional role, (2) cognitive and metacognitive processes in EBP learning, and (3) the learning experience as a catalyst for deep learning. Students described a shift from initial fear and perceived difficulty toward recognizing the practical value of EBP, accompanied by increased critical thinking, autonomous learning, and a growing evidence-informed professional identity. The flipped classroom model facilitated engagement and understanding, while the transfer of learning to clinical practice was influenced by contextual facilitators and barriers. Conclusions: Learning EBP through a flipped classroom was experienced as a transformative process that fostered critical thinking, self-regulated learning, and the construction of an evidence-oriented professional identity among nursing students. Strengthening information literacy skills and improving alignment between academic and clinical environments may enhance the sustainable application of EBP in clinical practice.

Nursing Reports doi: 10.3390/nursrep16050148

Authors: Won Ju Hwang Hwiyun Kim Nancy R. Reynolds

Background: Although pre-exposure prophylaxis (PrEP) has demonstrated strong clinical efficacy in preventing HIV infection among men who have sex with men (MSM), real-world utilization remains suboptimal. In South Korea, MSM constitute a major population within the domestic HIV epidemic; however, PrEP uptake has not increased pro-portionally to awareness. This discrepancy has been conceptualized as the “awareness–uptake gap,” reflecting multi-level barriers beyond individual knowledge. Purpose: This integrative review aimed to compare PrEP awareness, acceptance, and utilization among MSM populations in South Korea and international settings, and to identify structural, institutional, and psychosocial determinants contributing to the awaness, uptake gap. The study further sought to derive practical implications for nursing practice and health policy. Methods: An integrative literature review was conducted following Whittemore and Knafl’s five-step methodology and reported in line with PRISMA guidance. Electronic searches were performed in PubMed, Google Scholar, RISS, ScienceON, and DBpia for peer-reviewed studies published between 2015 and 2025 in English or Korean. The final search was completed on 31 January 2026. A total of 5952 records were identified, and 187 studies met the inclusion criteria after screening and duplicate removal. Quality appraisal was conducted using AXIS, Newcastle-Ottawa Scale, RoB 2.0, CASP, and MMAT according to study design, and the findings were synthesized within an environmental–structural–individual framework. Results: The included studies consistently showed that awareness of PrEP exceeded actual uptake. Across settings, the awareness–uptake gap was shaped by policy environment, service accessibility, stigma, privacy concerns, economic burden, institutional complexity, and provider preparedness. Comparative evidence from China, Thailand, Belgium and France, Brazil, and West Africa further suggested that awareness alone did not ensure uptake when service pathways were fragmented, culturally unsafe, or poorly understood. Conclusions: Closing the awareness–uptake gap requires integrated policy and practice strategies that extend beyond cost reduction. Strengthening confidentiality systems, simplifying service pathways, and enhancing provider competency—particularly through nurse-centered PrEP navigation and counseling models—may support more sustainable PrEP expansion among MSM populations in global settings.

Nursing Reports doi: 10.3390/nursrep16040147

Authors: Trinidad Maria Galera-Barbero Vanesa Gutierrez-Puertas Helder Jaime Fernandes Blanca Ortiz-Rodriguez Alba Sola-Martinez Lorena Gutierrez-Puertas

Background/Objective: In Spain, 99% of births occur in hospital settings, and planned home birth is neither funded nor regulated by the Public Health System. Despite growing interest in this birth option, qualitative evidence exploring the experiences of women who opt for a planned home birth after a previous hospital birth remains scarce, particularly in contexts where this practice is not integrated into the healthcare system. This study aimed to explore the perceptions and experiences of Spanish women who opted for a planned home birth following a previous hospital birth, focusing on the reasons that motivated this decision and the care received during the process. Methods: A qualitative descriptive design was employed. Semi-structured interviews were conducted between July and December 2025 with 19 women who had experienced a planned home birth in Spain after a previous hospital birth. Data were analysed using inductive thematic analysis following Braun and Clarke’s approach. The study adhered to the Standards for Reporting Qualitative Research (SRQR). Results: Three main themes emerged: (1) motives related to choosing a planned home birth, including negative hospital experiences characterised by loss of autonomy, medicalisation of birth without consent, and fragmented care; (2) seeking a physiological and humanised birth, reflecting women’s desire for empowerment, control, and a transformative experience, alongside barriers such as lack of professional support and financial burden; and (3) the need to increase visibility and establish regulation, highlighting demands for professional training, dissemination strategies, and integration of planned home birth into the Public Health System to ensure equitable access. Conclusions: Women who opted for a planned home birth after a hospital experience reported highly positive and empowering outcomes. However, the absence of regulation, professional support, and public funding creates significant inequalities. Integrating planned home birth into the Public Health System, educating healthcare professionals, and developing strategies to increase the visibility of planned home births are essential to guarantee women’s right to choose where they give birth.

Nursing Reports doi: 10.3390/nursrep16040146

Authors: Wínola Dafny Douglas de Oliveira Maria Eduarda Leite Pinto Ghirotti Álvaro Francisco Lopes de Sousa Adaiele Lúcia Nogueira Vieira da Silva Herica Emília Félix de Carvalho Marília Duarte Valim Aires Garcia dos Santos Júnior

Background: Safe medication administration is a fundamental aspect of nursing practice and a core component of patient safety. However, systemic failures, workload pressures, and educational gaps continue to contribute to medication errors, posing persistent challenges for healthcare systems. In this context, innovative educational technologies, particularly Artificial Intelligence (AI), have emerged as promising strategies to support the development of competencies related to safe medication administration. Methods: This scoping review aimed to map evidence on AI-based tools used to teach safe medication administration in nursing. The review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology and reported following the PRISMA-ScR guidelines. Searches were performed in PubMed, Scopus, Web of Science, LILACS, and Google Scholar, covering studies published between 2010 and October 2025 in English, Portuguese, and Spanish. Study selection was conducted in two stages, followed by standardized data extraction. Results: A total of 545 records were identified, of which only two studies met the eligibility criteria. The included studies, conducted in Israel and South Korea, evaluated a microlearning chatbot and Large Language Model (LLM)-based tools designed to support teaching safe medication administration. Both studies demonstrated improvements in knowledge and performance in tasks and simulations related to the medication process, as well as positive acceptability among participants. However, neither study assessed direct clinical outcomes, such as reductions in medication errors or preventable adverse events. Conclusions: Although AI-based educational tools show potential to enhance competencies related to medication safety in nursing, the available evidence remains limited. Further robust, multicenter, and comparative studies are needed to evaluate their impact on clinical outcomes and to support their integration into nursing education and practice.

Nursing Reports doi: 10.3390/nursrep16040145

Authors: Ahmed Yahya Ayoub Carin Maree Neltjie van Wyk

Introduction: Work engagement among nurse case managers is central to safe, efficient, person-centred care, yet organisational and team-level factors that support engagement or mitigate burnout remain poorly synthesised. Aim: To map organisational and team-level strategies that enhance work engagement or reduce burnout among nurse case managers and aligned roles, as well as to consider their applicability to Gulf health systems. Method: We conducted a scoping review in accordance with the Arksey and O’Malley framework as refined by Levac et al. and reported it in line with PRISMA-ScR and PRISMA-S guidance. Six databases and targeted sources were searched for English-language records published between 2015 and 2025. Two reviewers independently screened titles/abstracts and full texts against predefined eligibility criteria, charted data using a piloted form, and synthesised findings thematically against Job Demands–Resources (JD-R) domains. Results: Of 303 records identified, 248 were screened after deduplication, and 11 studies were included. Across nine health systems, findings were mapped to three JD-R domains: job resources, job demands, and personal resources. The most recurrent resource-related strategies involved structural supports, staffing stability, coordination infrastructure, and supportive leadership or team practices. Key demands included role complexity, high caseloads, coordination workload, discharge pressures, and staffing instability. Personal-resource approaches were fewer and mainly involved stress management, communication, and reflective practice interventions. Engagement was infrequently measured directly, and only one empirical intervention study originated from a Gulf health system. Conclusions: This JD-R-informed scoping review suggests that strengthening structural, staffing, and coordination resources, alongside supportive leadership and team climates, may be important for sustaining engagement and limiting burnout among nurse case managers. However, these findings should be interpreted as exploratory signals that map the current evidence landscape rather than definitive evidence of effectiveness. Multi-component JD-R-informed bundles in Gulf region health systems should therefore be prioritised for context-sensitive co-design, piloting, and evaluation.

Nursing Reports doi: 10.3390/nursrep16040144

Authors: Elisa Porcelli Carla Murgia Serena Caponetti Gennaro Rocco Alessandro Stievano Ippolito Notarnicola

Background: Spirituality and religious diversity are increasingly recognized as essential components of holistic nursing care in global healthcare systems. However, their integration into undergraduate nursing education remains heterogeneous and often insufficiently structured, creating a gap between professional values and students’ preparedness to address spiritual needs in culturally diverse clinical environments. This study aimed to explore nursing students’ perceptions, attitudes, and perceived competencies regarding spirituality, religion, and spiritual care. Methods: A descriptive exploratory survey was conducted on a sample of 69 third-year nursing students (69.6% female; majority aged ≤24 years) enrolled in two universities in Rome, Italy. Data were collected between May and July 2025 using the Nursing Care and Religious Diversity Scale (NCRDS), consisting of 31 items. Statistical analyses included descriptive statistics, internal reliability analyses, group comparisons, and multivariate regression models. Results: Students showed moderate levels of attention to patients’ spiritual needs (mean = 3.11, SD = 0.88) and integration of spirituality into care practice, while high importance was attributed to spiritual care skills. University education was perceived as only partially adequate. Multivariate analyses showed that students’ personal spirituality is positively associated with the assessment of spiritual needs and the perception of competence, while exposure to contexts characterized by greater religious diversity is associated with a lower perception of preparedness. Conclusions: The results highlight a discrepancy between professional values and perceived operational skills, suggesting the need to systematically integrate spirituality and religious diversity into nursing curricula. These findings highlight the need for a structured integration of spirituality and religious diversity into nursing curricula through targeted educational strategies in order to strengthen students’ competencies and promote truly holistic and person-centered care.

Nursing Reports doi: 10.3390/nursrep16040143

Authors: Anna Tsiakiri Konstantinos Tzanas Despoina Chrisostomidou Spyridon Plakias Foteini Christidi Christos Frantzidis Nikolaos Aggelousis Maria Lavdaniti Evangeli Bista

Background/Objectives: Cancer-related terminology is not merely descriptive and plays a critical role in shaping emotional responses, personal identity, and communication across clinical, social, and public spheres. Despite growing interest in the psychosocial dimensions of illness language, few studies have centered the lived experiences of individuals navigating cancer through the lens of terminology. This study explores how people living with and beyond cancer perceive, interpret, and emotionally respond to cancer-related language, focusing on the way terminology influences identity, stigma, and communicative interaction. Methods: A sequential mixed-methods design was employed. The quantitative phase involved 146 participants with a cancer diagnosis completing a structured questionnaire on preferred terminology and emotional impact. The qualitative phase followed, using open-ended questionnaires with 11 participants to deepen understanding of linguistic experiences. Thematic content analysis was used to identify patterns across narratives. Results: These findings reveal that labels such as “cancer patient” evoke strong negative emotional reactions, associated with stigma, fear, and identity reduction. Person-first and context-sensitive language was perceived as more respectful and empowering. Emotional responses to language varied widely, from fear to neutrality, shaped by speaker role, context, and time since diagnosis. Media representations were often seen as dramatizing or moralizing, reinforcing the need for communicative clarity, empathy, and education in both clinical and public discourse. Conclusions: Cancer-related language is a powerful psychosocial force. It shapes how individuals are seen and see themselves and can either reinforce stigma or foster dignity and resilience. This study highlights the urgent need for person-centered, context-aware communication practices across healthcare, media, and society.

Nursing Reports doi: 10.3390/nursrep16040142

Authors: Misa Iida Sumiyo Nabeshima Sayuri Kaneko Yuji Kamijo Toshio Kobayashi Yukako Ando

Objective: This study aimed to compare factors facilitating shared decision-making (SDM) in renal replacement therapy decision support between physicians and nurses using text mining analysis. Methods: A web-based survey was conducted among 250 physicians and 299 nurses between December 2024 and March 2025. Free-text responses regarding factors facilitating SDM were collected and analyzed using quantitative text analysis. Results: Valid responses were obtained from 103 physicians and 122 nurses. Both groups identified six factors, with three shared conceptual domains across physicians and nurses, reflected in three physician factors and four nurse factors. Common domains included “promoting patient and family understanding”, “enhancing staff education”, and “strengthening multidisciplinary collaboration”. Physicians emphasized structural and environmental factors, such as “establishing clinical systems”, “inter-institutional collaboration”, and “securing sufficient time”. In contrast, nurses highlighted practical and interpersonal aspects, including “understanding patients’ values and lifestyles”, “supporting patient-centered decision-making”, and “promoting team-based information sharing”. Conclusions: Factors that facilitate SDM in renal replacement therapy include perspectives common to both physicians and nurses, as well as profession-specific perspectives. These findings suggest that integrating organizational support and clinical skills development is crucial for promoting SDM in clinical settings.

Nursing Reports doi: 10.3390/nursrep16040141

Authors: Cátia Moreira Pedro Moutinho Paulo Alves Liliana Mota

Background/Objective: Leadership in nursing has been conceptualized as a multidimensional construct influencing organisational functioning and professional practice. Within the Full Range Leadership Model, leadership comprises transformational, transactional, and passive–avoidant dimensions that may coexist within individuals. This study aimed to examine how leadership dimensions coexist and interact among nurses and to explore their associations with professional characteristics within the FRLM framework. Methods: A cross-sectional quantitative study was conducted between November and December 2024 among 141 Portuguese nurses affiliated with a professional association dedicated to nursing leadership. Leadership behaviours were assessed using the Multifactor Leadership Questionnaire. A non-probability convenience sampling strategy was used. Descriptive and inferential analyses were performed using SPSS. Results: Transformational leadership emerged as the predominant behavioural pattern (M = 3.17, SD = 0.38), followed by transactional leadership (M = 2.51, SD = 0.46), with minimal laissez-faire behaviours (M = 0.83, SD = 0.50). Managers demonstrated significantly higher transformational scores (mean difference = 0.16, p = 0.018) and lower laissez-faire scores (mean difference = −0.27, p = 0.01) than specialists. Transformational leadership was positively correlated with transactional leadership (r = 0.309, p < 0.01) and negatively correlated with laissez-faire behaviours (r = −0.339, p < 0.01). Conclusions: The findings indicate a predominant transformational leadership profile among nurses, accompanied by complementary transactional behaviours and low passive–avoidant tendencies. The observed correlations support a dimensional interpretation of leadership consistent with the Full Range Leadership Model. These findings provide descriptive insight into leadership patterns within this nursing sample and may inform leadership development initiatives in comparable healthcare contexts.

Nursing Reports doi: 10.3390/nursrep16040140

Authors: João Miguel Almeida Ventura-Silva Olga Maria Pimenta Lopes Ribeiro Elaine Cristina Novatzki Forte Letícia de Lima Trindade Susana Filipa Mendes Castro Marlene Patrícia Ribeiro Diana Moreira Sanches Sónia Cristina Costa Barros Irina Alexandra Lopes Almeida David Rigor Lage Samuel Spiegelberg Züge

Objectives: This study aimed to evaluate the relationship between quiet quitting and burnout among nurses, considering the influence of sociodemographic and occupational factors in healthcare settings. Methods: This cross-sectional, observational, and quantitative study was conducted from April to July 2025 in health services in northern Portugal, involving 1097 nurses who completed a questionnaire, the Silent Employment Abandonment Scale, and the Shirom–Melamed Burnout Scale. Descriptive and inferential analyses examined associations between sociodemographic variables, work context, and outcomes. Results: The 1097 participating nurses showed a positive correlation between overall quiet quitting and total burnout across all domains. Burnout remained significantly associated with overall quiet quitting after adjustment, and physical and cognitive fatigue showed the most consistent independent associations across models. The strongest coefficients were observed for the ‘lack of motivation’ dimension. Conclusions: Quiet quitting was consistently associated with burnout among nurses after adjustment for sociodemographic and occupational factors. The pattern of results was stronger for physical and cognitive fatigue and for lack of motivation, supporting the interpretation of quiet quitting as an important correlation of occupational strain in nursing and reinforcing the need for organizational and leadership strategies that reduce fatigue and sustain professional engagement.

Nursing Reports doi: 10.3390/nursrep16040138

Authors: Sofía Martínez-León Alba Francisco-Sánchez Beatriz Rescalvo-Arjona Pedro Ruymán Brito-Brito Martín Rodríguez-Álvaro

Cardiopulmonary arrests are time-dependent emergencies where survival rates are quickly reduced without early intervention. BLS training programmes for teachers and schoolchildren must be mandatory, as they not only improve efficacy when performing the manoeuvres but also enhance willingness to do so. Background/Objectives: To analyse changes in knowledge and whether they are sustained in time after a theoretical–practical intervention led by nurses. To objectively analyse the quality of chest compressions according to the students’ group and age. Methods: A quasi-experimental study without a Control Group and with three measuring instances: Baseline (T0), Immediate post-intervention (T1) and at three months (T2). Knowledge was assessed by means of an ad hoc questionnaire; in turn, the chest compressions were evaluated using a mannequin with feedback. The longitudinal changes were analysed based on paired discordant answers. Descriptive analyses according to age and schooling level were performed. Results: There were 982, 756 and 509 students at T0, T1 and T2, respectively. A total of 206 records were paired at all three measuring moments. The intervention was associated with an increase in knowledge test scores, which is preserved at three months. Most of the questionnaire items presented positive changes or remained unchanged. The significant difference was maintained in 8 of the 10 questions. As for the compressions, a significant and positive correlation was found between age and overall score, depth and rate. The comparative analysis between the Lower Secondary Education and Higher Secondary Education groups found significant differences in those same variables, as well as a difference in release. Conclusions: Altogether, the results of this study contribute evidence about the effectiveness of BLS training among adolescents in a real-world context, underscoring the need for ongoing and age-adapted interventions.

Nursing Reports doi: 10.3390/nursrep16040139

Authors: Chrysi A. Fragkioudaki Enkeleint A. Mechili Petros Galanis Evridiki Patelarou Konstantinos Giakoumidakis Athina E. Patelarou

Background: Rapid technological progress has transformed healthcare systems through integrating electronic health (eHealth) into clinical practice. Consequently, nursing students, upcoming healthcare professionals, face new challenges arising from this digital transition. Adequate technological skills and eHealth literacy are essential to meet the requirements of contemporary healthcare environments. The aim of this study was to translate, culturally adapt, and validate a questionnaire measuring technophilia, Internet use, eHealth literacy, and nursing students’ attitudes toward technology and eHealth. Methods: A cross-sectional validation study was conducted using a convenience sample of Albanian undergraduate nursing students. After forward and backward translation, the instrument’s construct validity was examined using exploratory factor analysis (EFA). Cronbach’s alpha assessed internal consistency, and the relationships among the four constructs were explored using structural equation modeling (SEM). Results: A total of 357 undergraduate nursing students participated in the survey. EFA identified a clear four-factor structure corresponding to Technophilia, Internet Use, eHealth Literacy, and Technology and Electronic Health in Nursing Education, with all items demonstrating satisfactory factor loadings. Internal consistency of the four scales ranged from 0.692 to 0.852, indicating generally satisfactory reliability. Although the SEM model fit was below the recommended thresholds, the results provide some evidence for relationships among the constructs. Conclusions: The findings provide preliminary evidence for the reliability and validity of the adapted instrument and set a baseline for assessing Albanian nursing students’ knowledge, skills, and attitudes regarding technology and eHealth literacy. Several strategies can be developed based on this evidence to prepare nursing students for technologically advanced healthcare systems.

Nursing Reports doi: 10.3390/nursrep16040137

Authors: Marta Fernández Idiago Juan Francisco Velarde-García Oscar Arrogante Ignacio Zaragoza-García Beatriz Álvarez-Embarba Victor Fernández-Alonso Leticia López-Pedraza

Background: Emergency obstetric situations require rapid clinical decision-making, technical competence, and emotional preparedness to ensure safe and compassionate care for both mother and newborn. However, nursing students often have limited opportunities to experience such high-risk, low-frequency events during clinical placements. Simulation-based education has emerged as an effective strategy to prepare future nurses for caring in emergency contexts, allowing them to develop both technical and non-technical skills in a safe learning environment. This study aimed to evaluate the effects of a high-fidelity obstetric emergency simulation program on nursing students’ knowledge, perceived safety, and learning experience. Methods: A mixed-methods design was employed, combining a quasi-experimental pretest–posttest assessment without a control group and qualitative analysis of open-ended reflections. Eighty-two third-year nursing students participated in two simulation sessions addressing obstetric emergencies such as breech birth, shoulder dystocia, out-of-hospital delivery, eclampsia, postpartum hemorrhage, and maternal cardiac arrest. Data were collected using validated instruments measuring knowledge, perceived safety, and satisfaction and self-confidence in learning, and were analyzed using Wilcoxon signed-rank tests and thematic analysis. Results: Significant improvements were observed in specific knowledge areas related to complex obstetric maneuvers and in their perceived safety when managing emergency situations (p < 0.001, r > 0.40). Participants reported high levels of satisfaction and confidence in learning. Qualitative findings highlighted increased emotional preparedness, improved clinical reasoning, and recognition of the importance of teamwork and reflective debriefing in emergency care contexts. Conclusions: High-fidelity simulation appears to be an effective educational strategy for preparing nursing students to provide safe and confident care in obstetric emergencies. Integrating simulation into nursing curricula can strengthen both technical competence and the emotional readiness required for caring in urgent and high-pressure clinical situations.

Nursing Reports doi: 10.3390/nursrep16040136

Authors: Clint Moloney Gavin Beccaria Amy B. Mullens

Background: Chronic Obstructive Pulmonary Disease (COPD) remains a leading cause of emergency department (ED) presentation, hospitalisation, and preventable healthcare utilisation worldwide. Although guidelines advocate coordinated, preventative, and community-based management, care within ED settings often remains reactive and crisis-driven. Nurses occupy a central role in COPD management; however, the experiential dimensions of nursing practice and its contribution to improving patient outcomes are insufficiently understood. Objectives: To explore the lived experiences of patients, nurses and medical officers regarding COPD presentations to the ED, with particular focus on the nursing role in assessment, coordination, education, and identification of unmet and comorbid care needs. Methods: A qualitative phenomenological approach was undertaken across three regional Australian EDs. Purposive sampling recruited patients presenting with acute exacerbations of COPD and nursing and medical officers involved in their care. Semi-structured interviews were conducted and transcribed verbatim. Data were analysed using Braun and Clarke’s thematic analysis framework, supported by reflexive discussion and audit trails to enhance rigour. Results: Six interrelated themes were identified: (1) nursing within a “crisis first” model of care; (2) holistic assessment and translation of complexity; (3) education and care coordination as preventative nursing work; (4) relational care and therapeutic connection; (5) nurses as sentinels for undiagnosed comorbidities, particularly obstructive sleep apnoea; and (6) system pressures constraining optimal nursing practice. Participants consistently described nurses as the clinicians who stabilised acute episodes, interpreted contextual risks, coordinated services, and provided relational and educational support, yet whose preventative contributions were limited by time and organisational demands. Conclusions: ED nurses function as critical integrators between acute stabilisation and chronic disease management for patients with COPD. Formalising nurse-led assessment, education, coordination, and sleep-disordered breathing screening may reduce avoidable ED presentations and enhance patient-centred outcomes. Investment in structured nursing models represents a key opportunity for improving COPD care delivery.

Nursing Reports doi: 10.3390/nursrep16040135

Authors: Grace Crolly-Burton Gary Mitchell Clare McKeaveney Stephanie Craig

Background: Chronic kidney disease (CKD) is highly prevalent among older adults, particularly those living in care homes, where early identification and effective management are essential to improving outcomes. Aim: This scoping review aimed to explore and map educational interventions designed to support care home staff in the prevention, assessment, and management of CKD. Methods: A scoping review (ScR) was conducted and guided by the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for ScR (PRISMA-ScR) checklist. A systematic search of six major databases was conducted following the Joanna Briggs Institute methodology. Results: A total of 6599 records were identified and 5573 titles and abstracts were screened; 10 full texts were assessed, but no studies met the inclusion criteria. Conclusions: This empty review highlights a significant gap in the literature and reinforces the need for targeted research to develop and evaluate training interventions for care home staff managing residents with CKD.

Nursing Reports doi: 10.3390/nursrep16040134

Authors: Salomé Moreno-Vega José C. Vilches Francisco García-Pedrajas Isabel María Morales-Gil Cristóbal Rengel-Díaz

Background/Objectives: Breastfeeding initiation after cesarean section is frequently delayed due to postoperative routines and early mother–infant separation. Enhanced Recovery After Surgery (ERAS) protocols have been introduced in obstetrics to improve maternal recovery and may facilitate practices aligned with a family-centered model of care. The aim of this study was to evaluate the association between ERAS implementation and breastfeeding outcomes, including early feeding patterns and effective breastfeeding at discharge. Methods: An analytical longitudinal study was conducted including women undergoing scheduled cesarean section between January 2025 and November 2025 at Quirón Salud Málaga Hospital (Spain). A total of 131 women were enrolled in this study. Two groups were compared: an exposed group that received an ERAS protocol (n = 65) for scheduled cesarean section and a control group (n = 66) managed with conventional in-hospital care. An intrasubject analysis was conducted, and associations were assessed using odds ratios (ORs) with 95% confidence intervals (CIs). Multivariable logistic regression was performed to identify factors independently associated with effective breastfeeding. Results: The ERAS group showed a stable feeding pattern over time, with a high persistence of exclusive breastfeeding (Stuart–Maxwell χ2(2) = 1.14; p = 0.565). In multivariable analysis, ERAS implementation remained an independent factor (adjusted OR 3.79; 95% CI 1.50–9.55; p = 0.005), together with early skin-to-skin (adjusted OR 2.68; 95% CI 1.13–6.36; p = 0.026), as was breastfeeding support (adjusted OR 2.72; 95% CI 1.02–7.22; p = 0.045). LATCH scores were also higher in the ERAS group (p = 0.0005; r = 0.34). Conclusions: Women managed under ERAS presented a higher prevalence of exclusive breastfeeding at hospital discharge and better breastfeeding performance. ERAS implementation was associated with improved breastfeeding outcomes, possibly through clinical conditions that facilitate early contact and structured breastfeeding support.

Nursing Reports doi: 10.3390/nursrep16040133

Authors: Paschalina Lialiou Aglaia Katsiroumpa Parisis Gallos Olympia Konstantakopoulou Ioannis Moisoglou Olga Galani Maria Tsiachri Petros Galanis

Background/Objectives: Artificial intelligence (AI) has transformed healthcare delivery by revolutionizing the offering opportunities in prognosis, diagnosis, personalized treatment, and improving patient outcomes. However, little is known about the nurses’ attitudes toward the integration of AI-driven conversational technology and AI chatbots into clinical practice. The aim of our study was to investigate nurses’ attitudes regarding the use of AI chatbots as a tool for mental health support. Additionally, the study aimed to evaluate their levels of acceptance and fear toward AI, while examining the influence of demographic variables on these attitudes. Methods: A cross-sectional study was conducted. We employed the Artificial Intelligence in Mental Health Scale (AIMHS) to measure attitudes toward the use of AI-powered chatbots for mental health support. Additionally, we utilized the Attitudes Towards Artificial Intelligence Scale (ATAI) to assess nurses’ levels of acceptance and fear regarding artificial intelligence. Results: Technical advantages score in the AIMHS reflected low positive attitudes toward the technical aspect of AI chatbots for mental health support, while personal advantages score showed moderate positive attitudes toward the personal aspect of chatbots. ATAI scores indicated a moderate level of acceptance and fear toward AI. Results from multivariable analysis showed that increased age (b = 0.011, p-value = 0.018) and increased daily engagement with social media and websites (b = 0.058, p-value = 0.002) were significantly associated with more favorable technical attitudes towards AI-based mental health chatbots. Also, male nurses exhibited significantly more favorable attitudes toward AI-based mental health chatbots in terms of perceived personal benefits (b = 0.548, p-value < 0.001). Higher levels of digital technology competence were significantly associated with greater acceptance of artificial intelligence (b = 0.164, p = 0.032). Additionally, male nurses reported significantly higher acceptance of AI compared to their female counterparts (b = 1.587, p < 0.001). We found that lower financial status was significantly associated with heightened fear of AI (b = −0.329, p < 0.001). Conclusions: Nurses generally held moderately positive attitudes toward both AI-based mental health chatbots and AI more broadly. Several demographic factors were found to significantly influence these attitudes.

Nursing Reports doi: 10.3390/nursrep16040132

Authors: Yangama Jokwiro Qiumian Wang Jennifer Bassett Sandra Connor Edward Zimbudzi

Background: Nursing student experiences in the clinical learning environment have been described in many countries but less is known about student nurses in rural settings. Aim: To explore undergraduate nursing students’ experience of clinical placement in a rural setting and identify factors that influence their experience. Methods: A cross-sectional observational study was conducted with a convenience sample of 170 undergraduate nursing students in regional Victoria, Australia, who completed professional experience placements between January and June 2020. Following their placements, participants completed the Clinical Learning Environment, Supervision and Nurse Teacher (CLES+T) scale. Data were analysed using logistic regression models. Results: Completing clinical placements in medium to small rural towns or remote and very remote communities were associated with increased odds of high scores in the learning environment [odds ratio (OR) 2.90, 95% CI, 1.32 to 6.37; P = 0.01] and the supervisory relationship domains (OR 3.16, 95% CI, 1.40 to 7.14; P = 0.01). Female gender (OR 3.38, 95% CI, 1.12 to 10.19; P = 0.03), supervision by staff other than an educator (OR 2.71, 95% CI, 1.16 to 6.33; P = 0.02) and increased frequency of ad hoc (extra) supervision with a buddy nurse without the nurse educator (OR 2.55, 95% CI, 1.07 to 4.75; P = 0.03) were associated with increased odds of high scores in the role of nurse educator domain. Conclusions: In this study, nursing students reported valuing their exposure to smaller and more remote communities, the learning environments within rural and remote healthcare facilities, and the relationships they developed with supervising nurses. The findings also suggest that some students perceived greater value in supervision provided by clinical staff who were not in formal nurse educator or nurse facilitator roles. Given the limitations of the study, these observations should be interpreted cautiously and may warrant further investigation in broader contexts.

Nursing Reports doi: 10.3390/nursrep16040131

Authors: Helen Donovan

Background: Early-career registered nurses and midwives often encounter intense stressors that affect their physical, mental, emotional, and social well-being. While some challenges serve as valuable learning opportunities, others are traumatic and burdensome. These negative experiences can profoundly influence ongoing professional development and, for some, act as a catalyst for burnout and premature departure from the profession. Methods: This qualitative phenomenological study involved 51 registered nurses and midwives within their first three years of practice at an Australian hospital. The research aimed to identify the challenges faced by participants during their initial years and to explore how these experiences shaped their perceptions of ongoing practice. Results: Many participants in their second and third years of practice, who had difficult first-year experiences, described in detail the impact of their initial encounters on their formative nursing practice during the interviews. The challenges faced in the second and third years were often considered insignificant in comparison to the traumatic events of the first year. Some participants reported requiring long-term psychological support as a result of first year experiences and expressed uncertainty about continuing in the nursing profession. Conclusions: Ensuring that first-year experiences are positive, supportive, and rewarding is crucial for new nurses and midwives. When this period is marked by trauma, emotional distress can escalate, leading to burnout and an increased likelihood of professional attrition. Supporting graduates’ well-being and addressing their individual needs during these formative years is essential for workforce sustainability.

Nursing Reports doi: 10.3390/nursrep16040130

Authors: Erwin Dedi Afandi Usman M. Tang Aria Gusti

Background: Hospital-acquired infections (HAIs) pose significant safety risks, making nursing students’ behavioural intention during clinical rotations vital for prevention. Objective: To analyze the influence of Perceived Behavioural Control (PBC) and knowledge on students’ intention to maintain a safe clinical environment. Methods: A cross-sectional design was conducted with 242 nursing students at a Type A referral hospital in Pekanbaru, Indonesia. Participants were selected via simple random sampling. Data were collected using validated questionnaires measuring PBC (six indicators), knowledge (three subscales), and behavioural intention. Statistical analysis involved Chi-square tests for unadjusted Odds Ratios (OR) and binary logistic regression to calculate adjusted Odds Ratios (AOR) by entering all variables into the model simultaneously. Results: The majority of participants demonstrated high intention (66.5%) and high PBC (83.9%). In the univariate analysis, all six PBC indicators and general nosocomial knowledge were significantly associated with high intention (p < 0.05), with staff direction (OR = 5.96) and specific training (OR = 4.94) showing the strongest independent effects. However, when all environmental and cognitive variables were entered into the regression model simultaneously, only knowledge of personal protective equipment (PPE) use remained a significant independent factor (AOR = 2.66; 95% CI: 1.40–5.06, p = 0.003). The unadjusted OR emphasized the isolated influence of each factor, whereas the adjusted OR showed that technical knowledge was the only variable to retain significance after controlling for other factors. Conclusions: Technical knowledge regarding PPE use is the primary independent driver of nursing students’ intention to maintain a safe clinical environment. While environmental support and general knowledge are important foundational elements, clinical education should prioritize practical, technical training in protective measures to translate knowledge into behavioural intention effectively.

Nursing Reports doi: 10.3390/nursrep16040129

Authors: Nikolaos Kontodimopoulos Ioanna Anagnostaki Kejsi Ramollari Alexandra Anna Gasparinatou Michael A. Talias

Background: Artificial intelligence (AI) is increasingly integrated into healthcare systems, with important implications for nursing practice and clinical workflows. However, evidence regarding nurses’ digital skills, perceptions, and readiness to adopt AI-enabled technologies remains limited, particularly in national healthcare contexts such as Greece. Objectives: This study examined nurses’ digital skills, perceptions of AI, and readiness for AI adoption in clinical practice, and explored demographic and professional factors associated with these outcomes. Methods: A cross-sectional survey was conducted among 166 nurses working in two public hospitals in Greece. Results: Nurses reported moderate digital skills, with 59.1% indicating competence in email/video communication and 27.2% reporting adequate use of digital security tools, while exposure to AI remained limited (18.0% reported using AI products/services in daily life). Perceived professional impact of AI was moderate, whereas readiness for AI adoption was comparatively lower, with only 7.8% considering health professionals adequately prepared and 7.2% reporting adequate AI training. Statistical analyses indicated that educational level and computer literacy certification were positively associated with digital skills, whereas longer professional experience was negatively associated with readiness for AI adoption. Conclusions: These findings highlight a gap between general digital competence and preparedness for AI-driven healthcare applications and underline the need for targeted education and implementation strategies to support effective and ethical integration of AI in nursing practice. From a nursing workforce perspective, the results underscore the importance of integrating AI literacy into continuing professional education and aligning digital health implementation strategies with clinical nursing practice.

Nursing Reports doi: 10.3390/nursrep16040128

Authors: Francesco Sacchini Francesco Scerbo Karolina Kowalcze Paola Pantanetti Sophia Russotto Otilia Enache Stefano Mancin Cuc Thi Thu Nguyen Diego Lopane Francesca Marfella Gabriele Caggianelli Robert Krysiak Fabio Petrelli Giovanni Cangelosi

Background/Objectives: Chronic diseases pose a major challenge for healthcare systems, requiring integrated, patient-centered approaches that combine clinical management, prevention, and self-care. Lifestyle Medicine (LM) and lifestyle in general offers complementary frameworks to address these needs. However, the potential integration of LM within community nursing—particularly through the role of Family and Community Nurse (FCN)—has not been comprehensively synthesized. This narrative review aimed to synthesize international evidence on the role of community nursing—particularly FCN—in integrating chronic care management and LM view. Methods: For quality assessment, a narrative review was conducted in accordance with the SANRA criteria to enable the integration of heterogeneous evidence and a comprehensive synthesis of this complex topic. Literature searches were performed in the PubMed–Medline database, and the final screening of references from included studies was used to identify relevant manuscripts. Primary studies published in English over the past ten years were screened and analyzed using the PICOS framework. Sixteen eligible studies were included in the final synthesis. Results: The included studies indicated that nurse-led community interventions in LM view were associated with improvements in self-management, treatment adherence, and selected clinical outcomes, such as blood pressure, glycated hemoglobin, and physical activity levels. Empowerment-based approaches and the use of digital or telehealth tools supported patient engagement and health literacy. At the organizational level, multidisciplinary collaboration, shared protocols, and professional leadership emerged as key factors in sustaining continuity and quality of care, while organizational fragmentation and limited training in behavioral counseling were commonly reported barriers. Conclusions: Community nursing, particularly through FCNs, plays a relevant role in integrating chronic care management and LM approaches, contributing to improved self-management, treatment adherence, and selected clinical outcomes. The evidence highlights the importance of empowerment-based interventions, digital support tools, and multidisciplinary collaboration in enhancing care continuity and patient engagement. Addressing organizational barriers and strengthening behavioral counseling training remain essential to support effective implementation in community settings.

Nursing Reports doi: 10.3390/nursrep16040127

Authors: Piyanut Xuto Piyaporn Prasitwattanaseree Tareewan Chaiboonruang Lawitra Khiaokham Nittha Panjaruang Pattarada Chalermliamthong Piyawan Sritawan

Background: Nursing education faces challenges in developing critical thinking and digital literacy among Generation Z students, particularly in maternal–newborn care contexts where evidence-based practice is essential. Objectives: To evaluate the effectiveness of an AI-assisted podcasting intervention on critical thinking and digital literacy among nursing students and explore their experiences. Methods: A convergent mixed-methods design included 48 third-year nursing students who created educational podcasts using AI tools (Sci Space for literature search, Notebook LM for synthesis). Quantitative data were analyzed using paired t-tests; qualitative data from three focus groups (n = 15) underwent thematic analysis. Results: Critical thinking scores increased significantly from 89.71 (SD = 13.43) to 117.29 (SD = 9.94), (t = −13.332, p < 0.001). Digital literacy scores improved from 37.98 (SD = 5.84) to 46.94 (SD = 4.11), (t = −9.407, p < 0.001). Four themes emerged: transformation from anxiety to empowerment, AI as scaffold, distinct tool utility, and future clinical application. Conclusions: These findings suggest that AI-assisted podcasting has the potential to significantly enhance critical thinking and digital literacy among nursing students; however, results should be interpreted with caution given the pre–post design, single-institution sample, and use of researcher-developed instruments.

Nursing Reports doi: 10.3390/nursrep16040126

Authors: Lorena Liñán-Díaz María Desamparados Bernat-Adell Núria Vives-Díaz Vicente Bernalte-Martí

Background/Objectives: This study aimed to assess public stigma toward people with mental health problems and to examine the association between stigma and socioeconomic characteristics, personal mental health history, and contact with individuals with mental health problems. Methods: This observational, descriptive, and cross-sectional study was conducted among the general population in Spain using a sample of 404 participants, the majority of whom were women (71%), with a median age of 38 years (IQR = 26–49); most participants (86.4%) lived in urban areas. The participants completed a self-administered online questionnaire that explored socioeconomic variables and the Community Attitudes towards Mental Illness Scale (CAMI-S, Spanish version). Non-parametric tests (Mann–Whitney U, Kruskal–Wallis, and Spearman correlation), multiple linear regression, and statistical power analyses were performed. Results: The mean CAMI-S total score was 84.89 (SD = 11.122) out of 100, indicating relatively favourable attitudes toward people with mental health problems. Statistically significant associations (p-value ≤ 0.05) were found between CAMI-S scores and variables such as gender, age, place of residence, educational level, mental health disorder, and close contact with someone with mental health disorders. The regression model revealed four significant predictors of lower stigma: identifying as female (β = 2.523; p = 0.037), having a medium or higher educational level (β = 5.061; p = 0.002), experiencing a mental health diagnosis (β = 4.535; p = 0.014), and close contact (β = 4.183; p < 0.001). Conclusions: Social stigma toward people with mental health problems in Spain appears to be generally low, reflecting positive attitudes toward community integration. Being female, having higher education, and personal or close contact with mental health problems are associated with lower stigma.

Nursing Reports doi: 10.3390/nursrep16040125

Authors: Farzana Ashraf Urooj Sadiq Shahnila Tariq Bushra Awan Selma Yıldırım Carlos Laranjeira Murat Yıldırım

Background: Art therapy is an experiential, non-threatening intervention, used especially with children. The current study aimed to explore the effect of integrative art therapy on the psychological well-being (mental health and self-perception) of pediatric cancer patients. Methods: Using a single-group pre–post research design, each therapy session was individually administered to participants for approximately 45 min. Fourteen participants (Boys = 9, Girls = 5) were recruited from the inpatient oncology unit at Shaukat Khanum Memorial Cancer Hospital & Research Centre over two months. The age range was from 5 years to 13 years (M = 7.95; SD = 1.65). Mental health, including physical and emotional symptoms associated with cancer, was assessed using the Edmonton Symptom Assessment Scale-Revised, while self-perception was measured with the House Tree Person projective drawing test. Results: The integrative art therapy model significantly improved positive self-image (F = 16.77, p < 0.01) and reduced negative self-image (F = 99.11, p < 0.01) and mental health problems from the baseline to the second and third phases (F = 19.50, p < 0.01). Conclusions: This integrative approach demonstrates its potential as an effective method to enhance self-perception, alleviate mental health challenges, and improve overall quality of life.

Nursing Reports doi: 10.3390/nursrep16040124

Authors: Agnė Jakavonytė-Akstinienė Karolina Adomavičiūtė

Background: Dementia is one of the most common diseases of the elderly worldwide. Sharing experiences of caring for patients with dementia with other carers is essential to improve the quality of care, promote better outcomes, and learn from others. Aim: to explore nurses’ experiences of working with patients with dementia in Lithuanian supportive treatment and nursing hospitals. Methods: A qualitative descriptive design was employed in this study, with data collected through semi-structured interviews. Nurses with direct experience caring for patients with dementia in supportive treatment and nursing hospitals were recruited through purposive sampling. This sampling strategy was chosen to ensure that participants could provide rich, contextual, and experience-based insights into the phenomenon under investigation. Open-ended questions were divided into three themes: 1. Identifying nursing needs. 2. Care for people with dementia. 3. Patient behavior management and situation management. To ensure methodological rigor and transparency, the Consolidated Criteria for Reporting Qualitative Research (COREQ) were applied throughout the study’s planning, data collection, and analysis processes. Results: Nine nurses working in three different Lithuanian hospitals participated in the study. Theme 1: respondents reported that the needs of patients with dementia depend on their previous lifestyle and hobbies, as well as on essential physiological needs such as eating and drinking, bathing and personal hygiene, and the absence of pain. Theme 2: All participants emphasized that ensuring a safe environment is crucial for people with dementia. Theme 3: When faced with inappropriate patient behaviour, nurses attempt to calm the patient, speak gently, provide distraction, or, when necessary, temporarily separate the patient from others. Additional actions include administering medication and stabilizing the patient. Overall, these findings illustrate that dementia care requires continuous emotional presence, situational judgment, and adaptation to each patient’s individual needs. Conclusions: Patients with dementia require highly individualized care focused on nutrition, hygiene, pain control, and communication. Nurses’ daily activities centered on essential bodily care, medication management, and mobility support to maintain safety and prevent complications.

Nursing Reports doi: 10.3390/nursrep16040123

Authors: José Juan Gómez-Ramos Maria Eloísa Pérez-Ruíz Ingrid Patricia Dávalos-Rodríguez Bernardo Alejandro Mata-Villafan Jaime Jesús Antón-García Noé Moisés Flores-Jiménez Alejandro Marín-Medina

Background: Examining the relationship between burnout and absenteeism is important for understanding how chronic occupational stress translates into economic costs, reduced productivity, and deterioration in the health of nursing staff. The aim of this study was to evaluate absenteeism among nursing staff and its association with burnout from a gender perspective. Methods: A total of 154 nursing professionals with permanent contracts were included. An interview was conducted, which included the collection of sociodemographic data, characteristics related to their employment status, and the Maslach Burnout Inventory questionnaire in its Spanish-validated healthcare personnel version. The absenteeism rate was calculated using information from the hospital’s human resources department. The Mantel–Haenszel test was used to identify the association between burnout and absenteeism from a gender perspective. A p-value < 0.05 was considered statistically significant. Results: The prevalence of burnout was 70.1%; 52.6% reported absenteeism in 2024. The general nursing category was significantly associated with burnout (p = 0.039). Although no association was found between burnout and overall absenteeism, holding multiple jobs was identified as a determinant of partial absenteeism (p < 0.05). The hospital absenteeism rate was 4.8%. No statistically significant difference was found between burnout, gender, and absenteeism, with an adjusted odds ratio of 1.386 (95% CI: 0.75–2.65) after controlling for the effect of gender (χ2MH = 0.672, df = 1, p = 0.412). Conclusions: Nursing staff present a critical level of burnout. No statistically significant difference was found between burnout, gender, and absenteeism, which could indicate that gender roles in the workforce may be changing in our population.

Nursing Reports doi: 10.3390/nursrep16040122

Authors: Richard J. Gray Niall Higgins Piyanee Yobas Alessandro Stievano Daniel Bressington

Following the COVID-19 pandemic, there has been substantial growth in the amount of nursing research conducted online, with participants often recruited via social media platforms [...]

Nursing Reports doi: 10.3390/nursrep16040121

Authors: Marelle Grünthal-Drell Inge Timoštšuk Martin Argus

Background: Professional identity (PI) formation is a central developmental process associated with students’ well-being and ability to cope with professional demands. Healthy lifestyle (HL) and self-care are recognised as resources for sustaining long-term professional engagement. Although both PI formation and HL are considered important in nursing education, their interrelationship remains insufficiently understood. Objective: This review aimed to map and synthesise the existing literature on nursing students’ PI formation and its relationship with HL. Methods: A scoping review was conducted following the Arksey and O’Malley framework, Joanna Briggs Institute guidance, and PRISMA-ScR reporting standards. A systematic search was performed in Web of Science, Scopus, MEDLINE, and PubMed for peer-reviewed studies published 2015–2025. Results: Twelve sources met the inclusion criteria. The relationship between PI and HL is complex, indirect, and not yet clearly conceptualised. Rather than being defined through direct behavioural pathways, it appears to be mediated through mental well-being and related psychosocial aspects, as well as contextual influences. Tensions were identified between expectations of nurses as health role models and students’ lived behaviours. A well-developed PI may function as a protective resource against maladaptive coping and support-adaptive responses to academic and clinical stress. Conclusions: Both PI and HL are predominantly conceptualised as dynamic and contextually embedded processes. More integrative approaches addressing both behavioural and psychosocial dimensions are needed. Future research should adopt conceptually coherent and methodologically balanced designs across diverse educational contexts.

Nursing Reports doi: 10.3390/nursrep16040120

Authors: Denise Rodriguez Medrano Viola Cisari Emanuela Morenghi Daniela Cattani Simone Cosmai Giovanni Cangelosi Sara Morales Palomares Mauro Parozzi Stefano Mancin Fabio Petrelli Diego Lopane Beatrice Mazzoleni

Background/Aims: Resilience is a protective factor that helps nursing students manage the challenges of clinical education. However, the relationships between resilience, clinical internship satisfaction, and psychological well-being remain underexplored. To examine the associations between resilience, satisfaction with clinical internships, and psychological well-being among undergraduate nursing students across academic years and campuses. Methods: A cross-sectional observational study was conducted. A total of 302 undergraduate nursing students from four campuses of a northern Italian university completed three validated instruments: the 14-item Resilience Scale (RS-14), the Clinical Learning Quality Evaluation Index (CLEQI), and the 12-item General Health Questionnaire (GHQ-12). Descriptive, correlational, and multiple regression analyses were performed. Results: Resilience was positively associated with clinical learning satisfaction and inversely associated with psychological distress. Regression models confirmed resilience as a significant predictor of both clinical satisfaction (p < 0.01) and psychological well-being (p < 0.05), adjusting for age and gender. Conclusions: Resilience plays a crucial role in improving both educational satisfaction and psychological outcomes in nursing students. Integrating resilience-building strategies into nursing curricula could enhance learning experiences and well-being.

Nursing Reports doi: 10.3390/nursrep16040119

Authors: Helene Åvik Persson Anders Palm Karin Samuelson

Background/Objectives: Contemporary healthcare systems are characterised by rapid change, high workload, and staff shortages, creating conditions that may compromise care quality and generate turbulence in nursing. Turbulence has been discussed in nursing research. However, greater conceptual clarity is needed regarding its underlying factors and implications for nursing work. The aim of this study was to explore and analyse the concept of turbulence in nursing and its related factors. Methods: The study was conducted using the Simultaneous Concept Analysis Method involving a consensus group and a nursing care, expert group and included content validity index ratings as a validation technique. Results: Eight factors related to turbulence in nursing were identified. A conceptual model was developed to illustrate the interrelationships among these factors and their role within the turbulence concept. Based on this model and the demonstrated contextual interconnections, a comprehensive definition of turbulence in nursing was formulated. Conclusions: The study has achieved a deeper understanding of the concept “turbulence in nursing” through the identification of eight different, generally valid turbulence-related factors and their presumed impact on nursing care. A conceptual model of interacting forces in turbulence in nursing has been presented as both a detector and a compass for mapping and counteracting future tendencies toward turbulence in the work environment. The study enables healthcare professionals and leaders to detect and address emerging turbulence in nursing practice and education. By clarifying its underlying major related sources, the model serves as a practical guide for improving the work environment, strengthening team resilience, and ultimately enhancing patient safety and quality of care.

Nursing Reports doi: 10.3390/nursrep16040118

Authors: Mafalda Inácio Maria Carvalho Ana Paulino Patrícia Costa Ana Rita Figueiredo Elisabete Nunes Paulo Cruchinho Pedro Lucas

We would like to thank the author of the comment on our article [...]

Nursing Reports doi: 10.3390/nursrep16040117

Authors: Marlene Patrícia Ribeiro Renata Cristina Gasparino Olga Maria Pimenta Lopes Ribeiro

Background/Objectives: Professionalism reflects an individual’s connection, identity, and dedication to their profession. In nursing, it is associated with quality of care and professional respect, making its assessment essential for workforce development and management. However, valid and reliable instruments are needed to measure this construct across cultural contexts. Therefore, this study aims to evaluate the validity and reliability of the Portuguese version of the Nurses’ Professionalism Inventory (NPI). Methods: This methodological study used cross-sectional data collected from November 2024 to January 2025 in northern Portugal. Data were gathered from a convenience sample of 684 nurses who completed a sociodemographic questionnaire, the Portuguese NPI, the Conditions of Work Effectiveness Questionnaire II (CWEQ-II), and the Team Psychological Safety (TPS) scale. Confirmatory Factor Analysis (CFA) was conducted. Factor loadings and Average Variance Extracted (AVE) were used to assess validity. Internal consistency was evaluated using Composite Reliability, McDonald’s omega, and Cronbach’s alpha. Convergent validity was examined using Spearman correlations among NPI subscales, CWEQ-II dimensions, and TPS. Results: The Portuguese version of NPI preserved the original five-factor structure. The model showed acceptable fit indices (TLI = 0.90; CFI: 0.91; RMSEA = 0.10; SRMR = 0.08). All items had factor loadings above 0.50, except item 18 (0.42), which did not load significantly on any other factor; therefore, it was removed. This improved the AVE of the Professional Attitude subscale. The overall internal consistency was satisfactory, with all reliability coefficients ranging between 0.73 and 0.99. The correlations among the NPI subscales, CWEQ-II dimensions, and TPS were positive and statistically significant. Conclusions: This study demonstrates adequate measurement properties of the Portuguese version of NPI, supporting its use as a valid and reliable instrument.

Nursing Reports doi: 10.3390/nursrep16040116

Authors: Abdellah Selmi Zakaria Belrhiti

Background: Nurses’ motivation is essential for ensuring the quality of care and workforce retention. Understanding the underlying psychological mechanisms is essential, particularly through Self-Determination Theory (SDT). This approach clarifies how work environments influence work engagement and performance. Existing research has explored SDT in various contexts. However, little is known about how contextual and organizational factors specifically impact nurses’ motivation in low- and middle-income countries such as Morocco. This study contributes to addressing this gap. Objectives: This study explores how organizational factors within a Moroccan university hospital influence the BPNs’ satisfaction in a Moroccan teaching university hospital. Methods: An exploratory qualitative case study was used. Purposive sampling was used to select 26 participants, including nurse managers (n = 7), rehabilitation therapists (n = 5), pharmacy technicians (n = 4), nurses at the Hematology Department (n = 4), nurses at the Emergency Department (n = 4), and nurses in the outpatient consultation unit of the Otorhinolaryngology Department (n = 2). Data collection was conducted from March to June 2023, following ethical approval. Data analysis followed Yin’s five-step process, incorporating deductive and inductive coding, within- and cross-case thematic analysis, and iterative explanation-building. Results: Identified motivation emerged as the most frequently reported type, although BPNs’ satisfaction varied. Rehabilitation therapists consistently reported high levels of autonomy, competence, and relatedness, which were attributed to transformational leadership, task specialization, and a supportive organizational culture. In contrast, nurses experienced role ambiguity, transactional leadership, excessive workloads, and limited autonomy in decision-making, all of which contributed to unmet BPNs. Performance evaluations and financial incentives were widely perceived as unjust. Conclusions: This study shows that in LMIC hospital settings, nurses’ motivation depends on organizational support for their BPNs, especially in resource-constrained environments. The significant disparities between professions within hospitals indicate that supportive environments with autonomy-supportive leadership, clear roles, fair evaluation, and adequate staffing are both achievable and essential for motivating and retaining nurses.

Nursing Reports doi: 10.3390/nursrep16040115

Authors: Jiri Remr

Background/Objectives: In the context of nursing research and interventions, caregiver preparedness emerges as a pivotal concept. Informal caregivers play a central role in providing older adults with the vital nursing and social support they require. The present study evaluated the psychometric performance of the Caregiver Preparedness Scale (CPS) and tested the hypothesis that CPS scores differentiate between theoretically relevant known groups, including caregiving exposure and relationship-based indicators. Methods: A cross-sectional, face-to-face survey was conducted in June 2025 among the general population of Czechia. A total of 1024 interviews were included in the analysis. The sample was randomly split for exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The internal consistency of the scale was assessed using Cronbach’s α and McDonald’s ω, while inter-item associations were evaluated with Kendall’s tau-b. The known-groups validity was assessed through nonparametric group comparisons across caregiving exposure, relationship indicators within the caregiver–senior dyad, caregivers’ self-rated health, and their life satisfaction. Results: The CPS demonstrated high internal consistency (Cronbach’s α = 0.944; McDonald’s ω = 0.944), robust item–total correlations (0.730–0.863), and acceptable floor and ceiling effects. The EFA supported a dominant one-factor solution (eigenvalue = 5.749), which explained 71.9% of the variance and had strong loadings (0.750–0.894). The CFA demonstrated a good fit (RMSEA = 0.069, SRMR = 0.0155, CFI = 0.990, and TLI = 0.980) after allowing for a limited number of conceptually justified residual covariances. Known-groups analysis supported the sensitivity of the scale when the CPS scores were higher among primary (M = 25.30) and secondary (M = 22.73) caregivers in comparison to non-caregivers (M = 18.38). Moreover, statistically significant differences were observed among those who provided care during the past five years (M = 24.30) compared to those without such experience (M = 18.12). CPS scores also exhibited variation in relationship-focused indicators in the anticipated directions, and were lower among respondents reporting poorer health and lower life satisfaction. Conclusions: The study provided consistent evidence that CPS is a reliable, unidimensional measure with robust known-groups validity. The CPS can be regarded as a suitable research instrument for nursing research and for evaluating interventions aimed at supporting informal caregivers.

Nursing Reports doi: 10.3390/nursrep16040114

Authors: Giovanni Cangelosi

I have read the article entitled “Nursing Practice Environment in the Armed Forces: Scoping Review” by Inácio et al [...]

Nursing Reports doi: 10.3390/nursrep16040113

Authors: Pardis Momeni Elisabeth Winnberg

Background/Objectives: Parkinson’s disease (PD) is a progressive neurodegenerative disorder that affects both motor and non-motor functioning, leading to increasing dependency and long-term psychosocial consequences. As the disease progresses, partners often assume caregiving roles, resulting in shifts in responsibilities, communication patterns, and emotional dynamics within marital relationships. The aim of this study was therefore to explore the impact of Parkinson’s disease on marital relationships. Methods: A qualitative interview study with a retrospective design was conducted. Six couples were recruited through a movement disorders clinic and a lay organization in Sweden. Semi-structured, face-to-face interviews were conducted separately with each partner. Interviews were transcribed verbatim and analyzed using conventional content analysis with an inductive design. Results: Four main themes emerged: managing the disease together in partnership, nurturing the relationship, facing marital hardship, and planning an uncertain future. Couples who adopted a positive and pragmatic outlook, shared responsibilities, and maintained open communication seemed to be better able to manage the disease. Engaging in joint activities and reciprocal communication strengthened emotional closeness. In contrast, changes in roles, emotional distress, loss of intimacy, and communication avoidance challenged relationships. Thinking about the future evoked feelings of ambivalence, as couples balanced uncertainty with a need for security. Conclusions: Parkinson’s disease affects marital relationships, reshaping roles, emotional bonds, and future perspectives. The ability of nurses to address both partners’ needs and promote communication and shared coping strategies is essential to strengthening couples’ well-being.

Nursing Reports doi: 10.3390/nursrep16040112

Authors: Sebastjan Merlo Iztok Podbregar

Background: Job satisfaction among nursing staff is a key determinant of workforce stability, quality of care, and healthcare system sustainability. Nurses are increasingly exposed to high workload, staffing shortages, and complex organizational demands, which may adversely affect satisfaction and retention. The aim of this study was to examine job satisfaction among nursing staff working across different levels of healthcare in Slovenia and to identify organisational and sociodemographic factors associated with job satisfaction. Methods: A cross-sectional quantitative study was conducted among nursing staff employed in Slovenian healthcare settings. Data were collected using an online questionnaire that included the Job Satisfaction Survey (JSS) and sociodemographic, occupational, and organizational variables. Differences in job satisfaction across professional groups were examined using non-parametric tests. Associations between job satisfaction dimensions and explanatory variables were analysed using Spearman’s correlation coefficients, and multiple linear regression analyses were performed to identify independent predictors of job satisfaction. Results: Organizational and workload-related factors emerged as the most consistent determinants of job satisfaction across all JSS dimensions and total satisfaction. Unclear job task definitions, high workload, insufficient staffing, continuous healthcare provision, unfavourable work schedules, and limited opportunities for rest were associated with lower job satisfaction. In contrast, financially compensated overtime, supportive supervision, higher perceived employer quality, longer tenure in the current position were associated with higher satisfaction in several domains. Sociodemographic variables showed weaker and less consistent effects after adjustment for organizational characteristics. Intentions to change jobs within or outside the healthcare system were strongly associated with lower satisfaction across nearly all dimensions. Conclusions: Job satisfaction among nursing staff is shaped predominantly by modifiable organizational factors rather than demographic characteristics. Interventions aimed at improving task clarity, staffing adequacy, work organization, leadership practices, and recovery opportunities may enhance job satisfaction and contribute to a more sustainable nursing workforce.

Nursing Reports doi: 10.3390/nursrep16040111

Authors: Ângela Pragosa Sofia Roque Beatriz Araújo Élvio Jesus

Background/Objectives: Emergency Services (ESs) are highly demanding clinical settings where Nursing Practice Environments (NPEs) play a critical role in shaping professional- and care-related outcomes. International evidence suggests that unfavorable NPEs are associated with reduced job satisfaction, compromised care quality, and increased safety risks. This study aimed to describe NPEs and selected professional and care-related outcomes among ESs nurses in Portugal in 2018 and 2022. Methods: A descriptive, cross-sectional study was conducted using data from two national surveys of ESs nurses collected in 2018 (n = 390) and 2022 (n = 434). Data were collected through an online questionnaire including the Practice Environment Scale of the Nursing Work Index (PES-NWI), measures of job satisfaction, intention to leave, perceived quality and safety of care, safety culture, incident occurrence, and missed nursing care. Descriptive statistics were used to summarize results across both samples. Results: NPEs were predominantly classified as unfavorable in both samples, with around 70% of nurses working in unfavorable environments. The most compromised dimensions were staffing and resource adequacy, nurses’ participation in hospital affairs, and nurse manager ability, leadership, and support of nurses. Job satisfaction was low in both samples, and a high proportion of nurses reported an intention to leave the organization. Differences were observed between samples in perceived quality and safety of care, incident occurrence, and missed nursing care, particularly in relational and autonomous interventions. Collegial nurse–physician relations emerged as the only favorable dimension in both samples. Conclusions: The findings indicate that NPEs in Portuguese ESs were predominantly unfavorable in both study periods, reflecting structural and organizational challenges. These findings may be associated with nurses’ professional outcomes and perceived care quality and safety, highlighting the importance of targeted organizational interventions to improve practice environments.

Nursing Reports doi: 10.3390/nursrep16040110

Authors: Daniele Napolitano Alessio Lo Cascio Mattia Bozzetti Fabrizio Benedetti Giulia Petruccini Francesco Petrosino Silvia Cilluffo Francesca Trotta Davide Bartoli Ercole Vellone Gianluca Pucciarelli

Background/Objectives: Inflammatory bowel disease (IBD) requires sustained self-care, yet patients’ ability to manage daily treatment and symptoms is often shaped by the support provided by informal caregivers. Methods: Guided by the Middle-Range Theory of Self-Care of Chronic Illness, this multicentre cross-sectional study described caregivers’ contributions to self-care maintenance, monitoring, and management in IBD, and compared these contributions between caregivers of patients with Crohn’s disease (CD) and those of patients with ulcerative colitis (UC). Results: A convenience sample of 275 caregivers of adult outpatients with IBD was recruited across multiple Italian centres. Caregiver contribution was measured using the Caregiver Contribution to Self-Care of Chronic Illness Inventory, together with caregiver self-efficacy and selected sociodemographic and clinical variables. Caregivers reported substantial involvement across all self-care domains, with significantly higher contributions to self-care maintenance among caregivers of patients with CD than among those caring for patients with UC. Monitoring and management scores were similar across groups. Regression analyses indicated disease-specific patterns, with caregiver gender, education, employment status, and patient clinical characteristics showing differential associations with self-care domains. Conclusions: These findings underscore the central role of caregivers in supporting self-care in IBD and suggest that structured, caregiver-focused approaches embedded in routine clinical pathways may strengthen dyadic chronic illness management.

Nursing Reports doi: 10.3390/nursrep16040109

Authors: Ana Isabel Teixeira Sónia Martins Sara Lima Francisca Pinto Tânia Morgado Olga Valentim Hélder Alves

Background: It is well known that the university period is an important stage for young adults, involving significant academic and psychosocial adjustments. Students with greater Mental Health Literacy (MHL), which is defined as the knowledge, beliefs, and skills individuals have regarding mental health and mental illness, are better able to identify difficulties, seek help, and adopt healthier coping strategies. This study aims to describe the MHL levels of undergraduate health students and identify associated factors related to academic life, mental health and psychological state. Methods: A cross-sectional, self-administered, web-based survey was conducted using a non-probability sampling strategy among undergraduate students in health-related degrees at a Portuguese higher-education institution. Data was collected using a general characterization questionnaire and the following instruments: MHL Questionnaire, Academic Life Satisfaction, Subjective Happiness Scale, Psychological Well-Being Scale (PWBS), and Depression Anxiety Stress Scale. Bivariate and linear regression analyses were employed to identify factors associated with MHL. Results: A total of 306 students (79% female, mean age = 21.6 years; 59% nursing students) participated. The median MHL score was 70 (range: 30–80). The linear regression model explained 17.5% of the variance in MHL. Higher MHL levels were associated with having the course as a first choice, holding a previous degree, reporting taking psychotropic medication use (which may reflect previous mental health service utilization), and higher levels of psychological well-being. Conclusions: This study provides evidence on factors associated with MHL among undergraduate health students, suggesting that higher MHL is associated with greater psychological well-being, highlighting the potential importance of integrating strategies to promote MHL and psychological well-being in health and nursing education. However, these findings should be interpreted with caution due to the single-institution convenience sample, potential self-selection and reporting biases, and cross-sectional design, which limits causal inferences.

Nursing Reports doi: 10.3390/nursrep16040108

Authors: Natsumi Shimizu

Background/Objective: Older patients with end-stage renal disease who receive dialysis often discontinue treatment before the end of their lives. However, the trajectory of family caregiving in this specific context remains under-researched. This study explored the experiences of family members caring for older patients with end-stage kidney disease (ESKD), from the introduction of dialysis to end-of-life care. Methods: This qualitative descriptive study included three family members caring for older patients with end-stage renal disease who were undergoing dialysis in Japan. Data were collected through semi-structured, one-on-one interviews and analyzed using inductive qualitative content analysis within a qualitative descriptive design. Results: The results identified seven categories regarding the family’s experience from dialysis initiation to end-of-life care: Key findings, particularly regarding the terminal phase, included ‘shock of dialysis treatment discontinuation’, ‘last moments shared with the patient’, ‘nostalgic memories of the patient over time, and ‘reflections on end-of-life care for the patient.’ Families described a process wherein the sudden need for proxy decision-making, often without prior discussion, was linked to feelings of regret. Conclusions: The findings describe the continuous experiences of family caregivers in the Japanese context. These exploratory insights suggest that the absence of early Advance Care Planning may contribute to caregiver distress during the withdrawal phase. The results highlight the need for culturally sensitive renal supportive care that fosters communication and understanding of patients’ wishes to mitigate the ethical burdens on families.

Nursing Reports doi: 10.3390/nursrep16040107

Authors: Piyanut Xuto Lawitra Khiaokham Daniel Bressington Patompong Khaw-on

Background: The appropriateness of the World Health Organization (WHO) body mass index (BMI) cut-off (≥25 kg/m2) for gestational diabetes mellitus (GDM) screening in Asian populations remains controversial due to the “Asian phenotype,” characterized by higher body fat percentage and visceral adiposity at lower BMI values. This systematic review evaluated the screening and prognostic performance of pre-pregnancy BMI thresholds (≥23, ≥24, ≥25 kg/m2) for predicting GDM in Asian women. Methods: A systematic review and meta-analysis were conducted following the JBI Manual for Evidence Synthesis and PRISMA-DTA guidelines. A comprehensive search was performed in PubMed, Scopus, Embase, CINAHL, Cochrane Library, and Google Scholar from January 2015 to August 2024. Studies reporting screening and prognostic performance of pre-pregnancy BMI for GDM prediction in Asian populations were assessed using the QUADAS-2 tool. Data were synthesized using MetaBayesDTA for univariate random-effects meta-analysis of sensitivity and specificity. A supplementary DerSimonian-Laird random-effects meta-analysis of odds ratios (ORs) was conducted to assess the prognostic association between BMI thresholds and GDM risk. Results: A total of 13 studies were included in the review, comprising a total of 427,159 Asian pregnant women. Most included studies were conducted in East Asian populations, predominantly Chinese, and findings may not generalize to South or Southeast Asian subgroups. For the Asian-standard threshold (≥23 kg/m2; n = 3 studies), pooled sensitivity was 0.47 (95% CrI 0.45–0.49) and specificity was 0.71 (95% CrI 0.56–0.83). For the intermediate threshold (≥24 kg/m2; n = 7 studies), sensitivity was 0.31 (95% CrI 0.25–0.37) and specificity 0.84 (95% CrI 0.80–0.88). For the WHO standard (≥25 kg/m2; n = 3 studies), sensitivity was 0.31 (95% CrI 0.11–0.61) and specificity 0.80 (95% CrI 0.45–0.95). Heterogeneity was extremely high for BMI ≥ 25 kg/m2 (I2 = 92% for sensitivity), substantially limiting the interpretability of pooled estimates for this threshold. Conclusions: Based on low-certainty evidence from three studies with very high heterogeneity, the WHO BMI criterion (≥25 kg/m2) appears to have clinically insufficient sensitivity for GDM detection in East Asian populations. The Asian-standard threshold (≥23 kg/m2) shows improved prediction (moderate-certainty evidence) but still misses approximately 53% of true positives. Supplementary OR meta-analysis confirms that all three thresholds are significantly associated with GDM risk (pooled ORs 1.80–2.38), though effect sizes are modest. BMI alone is insufficient for GDM screening and should be integrated into multifactorial risk assessment strategies. These findings apply primarily to East Asian populations and may not generalize to South or Southeast Asian subgroups.

Nursing Reports doi: 10.3390/nursrep16040106

Authors: Van Hoi Le Huu Thuan Vo Thi Bich Thuy Tran My Hanh Dang Cai Thi Thuy Nguyen Thi Anh Nguyen

Background/Objectives: Despite extensive research on nurses’ knowledge and attitudes toward pain management globally, limited evidence exists regarding the actual implementation of multimodal pain management practices among Vietnamese nurses. This study aimed to (1) assess nurses’ implementation of pharmacological and non-pharmacological postoperative pain management interventions, (2) examine the relationships among knowledge, attitude, and practice (KAP), and (3) identify predictors of competent practice with attention to the relative contributions of formal training versus clinical experience. Methods: A cross-sectional survey was conducted among 230 nurses working in Urology Departments from two tertiary public hospitals in Ho Chi Minh City, Vietnam, between April and June 2024, focusing on postoperative pain management. Pain management knowledge, attitudes, and practices were assessed using validated instruments. Independent samples t-tests compared trained versus untrained nurses. Multiple linear regression identified predictors of practice competency. Effect sizes (Cohen’s d) quantified the magnitude of training effects. Results: Nurses demonstrated moderate-to-good competency, with pharmacological interventions (M = 3.74) implemented more consistently than non-pharmacological interventions (M = 3.48, p < 0.001). Trained nurses significantly outperformed untrained nurses across all domains with large effect sizes (Cohen’s d = 1.34–1.54). A clear hierarchy emerged in non-pharmacological practice: environmental (M = 4.01) > physical (M = 3.69) > cognitive–behavioral (M = 3.27) > spiritual (M = 2.60). Strong KAP correlations were observed (r = 0.70–0.85, p < 0.001). Prior training was the strongest predictor of both pharmacological (β = 1.31, p < 0.001) and non-pharmacological practice (β = 0.58, p < 0.001), while clinical experience showed no significant effect (p > 0.40). Conclusions: This study provides evidence that formal training—not clinical experience—is strongly associated with competent postoperative pain management practice among Vietnamese nurses, with large effect sizes demonstrating practical significance. The strong KAP relationships support targeted educational interventions addressing knowledge gaps to improve practice. These findings have implications for nursing education research in Vietnam and similar healthcare settings.

Nursing Reports doi: 10.3390/nursrep16040105

Authors: Janet Vaca-Auz Karen Jaramillo-Jácome Melisa Chacón-Guerra Jorge L. Anaya-González

Traditional palliative care education may limit the development of clinical competencies and attitudes required to alleviate suffering and improve quality of life. Gamification has been proposed as an alternative educational strategy in this field. Background/Objectives: This study aimed to assess the association between gamification-based intervention and palliative care knowledge among nursing students at a public university. Methods: This single-group, pre–post-intervention study was conducted in the Nursing Program of the Universidad Técnica del Norte, Ecuador, including 136 students from the accessible population. Palliative care knowledge was assessed before and after the intervention using the validated Palliative Care Quiz for Nursing (PCQN-SV). Student satisfaction and Moodle usability were assessed using a 10-item Likert-type questionnaire. The gamified educational intervention was delivered online over 60 h. Data were analyzed using descriptive statistics and Wilcoxon signed-rank tests for paired comparisons, and exploratory logistic regression analyses were conducted to evaluate contextual differences across hospitals. Statistical significance was set at α = 0.05. Results: The mean age was 22.9 years (SD = 1.89), and 73.5% were female. Knowledge scores increased significantly after the intervention (Wilcoxon signed-rank test, p < 0.001; r = 0.35). The proportion of students achieving sufficient knowledge (≥13 correct responses) increased from 27.2% (37/136) at baseline to 49.3% (67/136) post-intervention. Contextual analysis indicated variability across clinical training sites, with Lago Agrio showing higher odds of sufficient knowledge (aOR = 3.25; 95% CI [1.26–8.41]; p = 0.015). Conclusions: The gamified intervention was associated with increased palliative care knowledge among nursing students. Heterogeneity across hospitals suggests that contextual factors may influence the magnitude of change.

Nursing Reports doi: 10.3390/nursrep16040104

Authors: Sergio Mies-Padilla Claudio-Alberto Rodríguez-Suárez Aday Infante-Guedes Héctor González-de la Torre

Background/Objectives: Simulation-based education often lacks personalization, focusing on technical competence rather than individual student profiles. This protocol describes a study designed to evaluate whether adapting gamified narratives to nursing students’ personality profiles has the potential to support academic performance in obstetrics. This study aims to validate the integration of psychometric profiling and AI as a sustainable strategy for personalized clinical training. Methods: A cluster-randomized controlled longitudinal pilot trial will be conducted at the University of Atlántico Medio. The protocol has been submitted for registration at ClinicalTrials.gov (Registration Pending). Thirty-eight second-year nursing students meeting inclusion criteria (excluding repeaters or those with prior specialized training) will be assigned by natural practice to either a control group (generic gamification) or an experimental group (gamification adapted according to Player Personality and Dynamics Scale profiles using AI-generated content). The intervention comprises four clinical simulation sessions focusing on pregnancy and childbirth, which are managed via the Wix platform. The primary outcome is academic performance, measured as “Learning Gain” (post-test scores minus pre-test scores). Secondary outcomes include student satisfaction measured via the Gameful Experience Scale. Data will be analyzed using Mann–Whitney U tests to compare overall efficacy and intragroup evolution. To minimize observer bias, knowledge assessments will utilize automated, objective scoring, and participants will be blinded to the study hypothesis. Expected Outcomes: The study aims to establish the technical and pedagogical feasibility of integrating AI-adapted narratives into nursing curricula. It is anticipated that the personalized approach will show positive trends in learning gains and engagement patterns, providing a baseline for larger multicenter trials. Conclusions: This protocol presents a framework for “Precision Education” in nursing, shifting from “one-size-fits-all” simulations to student-centered adaptive training. The use of Generative AI makes such personalization sustainable and cost-effective for health science faculties.

Nursing Reports doi: 10.3390/nursrep16030103

Authors: Tomoharu Genka Midori Kamizato

Background/Objectives: Head and neck cancer survivors experience many late toxicities following radiation therapy. This study aims to identify symptom clusters of late toxicities and their related factors in head and neck cancer survivors. Methods: A cross-sectional study was conducted with 83 survivors (pharyngeal or laryngeal cancer) who had received radiation therapy at least one year earlier. Nine late toxicities were assessed using the Japanese version of the Patient Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) and a custom questionnaire. Quality of life (QoL) and related factors were evaluated with the European Organization for Research and Treatment of Cancer (EORTC QLQ-C 30), Hospital Anxiety and Depression Scale (HADS), UCLA Loneliness Scale, and Liebowitz Social Anxiety Scale (LSAS). Exploratory factor analyses and multiple regression analyses were performed. Results: All participants reported at least one symptom. Dry mouth (90.4%) and difficulty swallowing (72.3%) were particularly prevalent. Exploratory factor analysis (EFA) identified two symptom clusters (SCs): an oropharyngeal dysfunction cluster (pain, trismus, taste changes, difficulty swallowing, hoarseness) and a dry mouth cluster (dry mouth, sticky saliva). Regression analysis indicated that higher scores in both clusters were significantly associated with lower global QoL (oropharyngeal dysfunction SC: β = −0.427, p < 0.001; dry mouth SC: β = −0.268, p = 0.009). Chemoradiotherapy (CRT) was also significantly associated with higher cluster scores (oropharyngeal dysfunction SC: β = 0.233, p = 0.020; dry mouth SC: β = 0.343, p = 0.001). Conclusions: Late toxicities following radiation therapy include two clusters: oropharyngeal dysfunction cluster and dry mouth cluster. Head and neck cancer survivors with higher SC scores had lower global QoL scores and had undergone CRT. These findings may aid in the assessment and self-management support of head and neck cancer survivors after radiation therapy.

Nursing Reports doi: 10.3390/nursrep16030102

Authors: Claudia Raluca Balasa Virzob Florin Gabriel Crisan Camelia Melania Fizedean Norberth-Istvan Varga Mircea Iurciuc Adelina-Marioara Gherman Stela Iurciuc

Background/Objectives: Secondary traumatic stress (STS) affects healthcare professionals indirectly exposed to patients’ trauma, and emergency personnel may be particularly vulnerable. Evidence from Romania is limited. Methods: We conducted a cross-sectional survey (July–August 2025) among emergency medical professionals working across the integrated emergency care system in Timisoara, Romania (prehospital ambulance/SMURD services and hospital Emergency Department). Secondary Traumatic Stress (STS) symptoms were measured using the 17-item Secondary Traumatic Stress Scale (STSS; item coding 1–5). We summarized STSS total/subscale scores and reliability, classified total scores into severity categories (0–68 metric), compared scores by workplace, sex, and professional role, and examined associations with age and years of experience. Results: The analytic sample included 145 participants (49.0% women), with a median age of 44 years [33–50] and median professional experience of 10 years [5–15]. Mean total STSS was 36.4 (SD 11.9; range 17–66) and internal consistency was high (Cronbach’s alpha = 0.92). Most participants were classified as little/no STS (77.2%), followed by mild (12.4%), moderate (5.5%), high (4.1%), and severe (0.7%). STSS scores did not differ significantly between ambulance service and ED/UPU staff. Women reported higher total STSS than men (39.0 vs. 33.9; p = 0.010), with significant differences for intrusion (p = 0.035) and arousal (p = 0.004). Role differences were significant for total STSS, intrusion, and arousal (p ≤ 0.031), with nurses scoring higher than ambulance drivers/attendants in post hoc comparisons. Years of experience showed small positive correlations with total STSS (r = 0.18, p = 0.032) and intrusion (r = 0.21, p = 0.010); age was associated with intrusion only (r = 0.22, p = 0.008). Conclusions: In this Romanian emergency care cohort, most participants reported low STS severity, but a clinically relevant minority had moderate-to-severe symptoms. Higher symptom burden among women and nurses suggests groups that may benefit from targeted monitoring and support within the integrated emergency system.

Nursing Reports doi: 10.3390/nursrep16030101

Authors: Yoshitomo Fukuura Yukako Shigematsu Yumi Mizuochi

Background/Objectives: Research that systematically identifies the components of a psychosocial workplace environment tailored to people with mental illness is limited. This scoping review aimed to map the existing literature and clarify the key concepts of a desirable workplace environment from a psychosocial perspective that enables sustainable employment for people with mental illness. Methods: A scoping review was conducted using the Joanna Briggs Institute methodology. Five databases, including PubMed and Scopus, were searched to extract original English-language, peer-reviewed research articles published between 2003 and 2025 on workplace environments for individuals with mental illness. Two independent reviewers screened the records and selected 16 studies using the population, concept, and context framework. Following data extraction, qualitative inductive analysis was conducted for category development. Results: Five categories and 17 subcategories were identified as psychosocial workplace environments promoting sustained employment: (1) Growth-supportive environments that leverage individual strengths and promote self-actualization; (2) recognition-affirmative environments that respect individual characteristics and are based on fair evaluation and acceptance of diversity; (3) a low-psychological-strain environment featuring predictability and autonomy; (4) a multilayered support network; and (5) a support environment based on interprofessional collaboration and system utilization. Conclusions: Workplace environments supporting the sustained employment of individuals with mental illness appear to involve a multilayered structure integrating self-actualization, predictable and autonomous job design, and comprehensive interprofessional support. The findings provide a preliminary concept map; however, gaps remain in the types and quality of evidence. Future primary research and formal concept analysis are required to validate these components and address existing methodological and contextual gaps.

Nursing Reports doi: 10.3390/nursrep16030100

Authors: Orejeta Diamanti Giovanna Artioli Paolo Pellegrino Francesca Bonadies Matteo Bernardi Alberto Camuccio Mirsad Pasalic Donato Antonio Rotondo Federica Dellafiore

Background/Objectives: Oral mucositis (OM) is a common complication in onco-hematological patients undergoing chemotherapy and hematopoietic stem cell transplantation, negatively affecting comfort, nutrition, and quality of life. Despite existing assessment tools and recommendations, OM management—particularly non-pharmacological approaches—remains inconsistent, and evidence on nurses’ perspectives and contextual factors is limited. This study explored nurses’ perceptions and experiences regarding non-pharmacological treatments for OM, including educational needs and barriers and facilitators to implementation in clinical practice. Methods: A qualitative descriptive study using inductive content analysis was conducted. Semi-structured interviews were carried out with nurses working in onco-hematological settings in Italy. Data were analysed according to the Elo and Kyngäs framework. Results: Twelve nurses with extensive experience in onco-hematology and transplant care participated in the study. Five main themes emerged: (1) education and training pathways; (2) approaches to mucositis management; (3) nursing competence in OM care; (4) interprofessional collaboration; and (5) governance of practice, including protocols and guidelines. Findings highlighted strong experiential competence, high levels of nursing autonomy in assessment and patient education, and effective interprofessional collaboration, particularly in specialised settings. However, training pathways were predominantly informal, and the availability and use of protocols varied widely across clinical contexts. Conclusions: Non-pharmacological management of OM appears to be sustained primarily by advanced nursing competence and a specialised clinical culture rather than by structured education and standardised governance. Addressing educational gaps and promoting shared protocols may enhance the consistency, quality, and equity of supportive care while ensuring that the findings are clearly reflective of nurses’ experiences.

Nursing Reports doi: 10.3390/nursrep16030099

Authors: Eric Lim Shireesha Potla Jaya Dantas Takeshi Hamamura Sender Dovchin Stephanie Dryden Ana Tankosić

Background: Australia’s increasingly multicultural landscape has seen a rise in culturally and linguistically diverse populations, many of whom face subtle and systemic forms of discrimination known as “new racism”. Objective: Underpinned by a person-centred and holistic framework, which recognises individuals as experts in their own lived experiences and emphasises strength-based, culturally situated understandings of well-being, this paper reports on a study that explores how culturally and racially marginalised diverse people in Australia cope with the mental health impacts of new racism. Design: A qualitative descriptive approach was employed in this study. Participants: Thirty participants from ten culturally and linguistically diverse communities participated in eight focus groups, providing rich insights into their lived experiences. Methods: Data were collected through semi-structured focus-group interviews conducted between March and June 2025. Data were analysed using Braun and Clarke’ method of thematic analysis. Results: Thematic analysis revealed four key coping strategies: (1) acceptance of immutable identity traits to foster resilience, (2) emotional ventilation within culturally safe spaces, (3) self-growth and empowerment through reflection and adaptive practices, and (4) assertive responses to racism when necessary. While some participants reported psychological distress, many demonstrated resilience and resourcefulness, challenging deficit-based assumptions often found in the existing literature. Findings underscore the importance of culturally responsive mental healthcare, including peer support, emotional safe spaces, and strength-based interventions. Conclusions: This study offers a holistic understanding of how culturally and racially marginalised people cope with new racism and its mental health impacts. The findings highlight the critical need for person-centred, culturally responsive, and equity-focused mental health support, providing actionable guidance for nursing practice and policy development.

Nursing Reports doi: 10.3390/nursrep16030098

Authors: Sara Dionisi Emanuele Di Simone Aurora De Leo Gloria Liquori Nicolò Panattoni Leandro Amato Alessandra Improta Sofia Taborri Giovanni Battista Orsi Noemi Giannetta Marco Di Muzio

Objectives: This study aims to identify factors associated with medication errors among home care nurses in Italy, focusing on the relationships between knowledge, attitudes, and behaviors, and assessing how sociodemographic and professional characteristics influence these dimensions. Methods: A nationwide cross-sectional survey was conducted using the Italian validated version of the Knowledge, Attitudes, and Behaviors in Medication Error in the Home Care setting questionnaire, previously developed and validated for home care settings. Multivariate logistic regression analyses were performed to explore associations among knowledge, attitudes, behaviors, and selected sociodemographic variables because the survey was disseminated through open online channels, and the response rate could not be calculated. Results: A total of 320 nurses participated. Younger age and holding a non-university degree were significantly associated with higher knowledge levels. Internet access at the workplace emerged as the only significant factor associated with medication error prevention for both positive attitudes [OR = 0.412, 95% CI: 0.197–0.861; p = 0.018] and correct behaviors [OR = 0.456, 95% CI: 0.216–0.962; p = 0.039]. Furthermore, attitudes positively predicted knowledge [OR = 2.226, 95% CI: 1.291–3.962, p = 0.004], and both knowledge and attitudes significantly influenced behaviors. Conclusions: The study highlights the interdependence of knowledge, attitudes, and behaviors in preventing medication errors in home care. While internet access and formal education are associated with differences in knowledge, attitudes, and behaviors, the relationships observed warrant further investigation. These findings underscore the potential value of targeted educational strategies and resource availability to support nurses in promoting safe practices.

Nursing Reports doi: 10.3390/nursrep16030097

Authors: Fabrizio Benedetti Giulia Imperatori Valeria Amatucci Alessio Lo Cascio Simone Amato Daniele Napolitano

Background/Objectives: While caregiver burden in Inflammatory Bowel Disease (IBD) is well documented, the association between informal support and patient-reported outcomes (PROs), particularly health-related quality of life (QoL) and psychological well-being, remains underexplored. This systematic review synthesizes evidence on the association of informal caregiving on patient-reported QoL and psychosocial outcomes and maps the available evidence on clinical outcomes. Methods: Following international reporting guidelines and prospective protocol registration, a systematic search was conducted across five electronic databases between May and October 2025. Observational studies in adults with IBD assessing informal support and patient-reported or psychosocial outcomes were included. Owing to substantial heterogeneity in constructs and outcome measures, results were synthesised using a structured Synthesis Without Meta-analysis (SWiM) approach. Methodological quality was assessed using standardised critical appraisal checklists. Results: Six cross-sectional studies involving 1036 patients and 417 informal caregivers met the inclusion criteria. All studies reported a positive direction of association between higher levels or better quality of informal caregiver support and improved patient-reported QoL. Several studies identified psychological and relational factors, such as lower patient psychological distress and caregiver-related positive feelings and caring ability, as mechanisms statistically associated with this relationship. Conclusions: Available cross-sectional evidence suggests a positive association between informal support and patient-reported QoL/psychological outcomes in IBD, but causality cannot be inferred. Priorities include longitudinal dyadic studies and caregiver-inclusive interventions, alongside standardised definitions and measures of support.

Nursing Reports doi: 10.3390/nursrep16030096

Authors: Anat Romem Zvika Orr

Background: Professional identity and ethical integrity are foundational to nursing practice and are shaped in part by educational experiences. This study evaluated an online Holocaust and genocide educational seminar delivered to fourth-year Bachelor of Science in Nursing (BSN) students and explored how students linked seminar content to professional identity formation, ethical vigilance, and patient advocacy. Methods: We conducted a descriptive mixed-methods educational evaluation. Students completed an anonymous pre-seminar survey (demographics, motivations for studying nursing, self-identified desirable professional qualities, and self-rated knowledge of the Holocaust and other genocides) and an anonymous post-seminar feedback survey with four open-ended questions. Quantitative items were summarized descriptively; qualitative data were analyzed using inductive qualitative content analysis. Results: Of the 205 students who attended the seminar, 133 completed the pre-seminar survey, and 110 completed the post-seminar survey. Students reported high baseline knowledge of the Holocaust but limited knowledge of the Armenian and Rwandan genocides. The five themes that emerged are as follows: (1) ethical judgment and the influence of nurses; (2) patient advocacy and social justice; (3) the effect of historical and contemporary trauma on students’ learning experience; (4) genocide awareness and prevention; and (5) approaches to education and content presentation. Conclusions: Carefully facilitated Holocaust and genocide education, delivered through interactive online pedagogy and structured debriefing, may support late-stage nursing students’ reflection on ethical integrity and professional identity during the transition to professional practice.

Nursing Reports doi: 10.3390/nursrep16030095

Authors: Susan J. Rosenkranz Shirin O. Hiatt Amy Leatherwood Michael F. Chang Lissi Hansen

Patients with end-stage liver disease (ESLD) and their caregivers experience extensive physical, psychological, and social burdens and needs for resources. However, empirical evidence on patients’ and caregivers’ specific reported use of resources to help manage ESLD is lacking. Understanding the type and helpfulness of resources used could strengthen clinical care to address individual needs for resources. Aim: To examine and compare resources patients and caregivers identified as being most helpful in managing ESLD in relation to resources they felt would be helpful. Methods: Patients with ESLD and their caregivers responded in writing to two open-ended questions as part of a survey: (1) What resources have you found most helpful in dealing with patient’s liver disease? and (2) What resources would be helpful in dealing with patient’s liver disease? Conventional content analysis was used to identify resource categories. Results: A total of 192 patients and 198 caregivers completed surveys. We identified two major resource domains—medical and non-medical—and five categories within each. Analysis revealed participant group- and disease severity-based differences in helpful resources. Conclusions: Proactively engaging patients and caregivers early in the course of illness to identify relevant resources that might facilitate ability to manage ESLD. An interprofessional care approach would facilitate efforts supporting financial, social, spiritual, emotional, and mental health needs. Future longitudinal research of unique resource needs along the disease trajectory may help to develop effective interventions.

Nursing Reports doi: 10.3390/nursrep16030094

Authors: S. Raquel Ramos Rex Ying

The exponential growth of artificial intelligence has transformed global information ecosystems, introducing complex technological challenges that extend far beyond its computational capabilities [...]

Nursing Reports doi: 10.3390/nursrep16030093

Authors: Miguel Angel Jorquera-Ruzzi Cristina Ramo Tello Maria José Durà-Mata Irma Casas

Background: Fatigue is a multidimensional and subjective experience, and it is one of the most common symptoms of multiple sclerosis (MS), affecting up to 80% of patients and acting as a major driver of work disability. Despite its clinical significance, existing assessment tools often lack conceptual clarity or remain too lengthy for routine clinical use. Objective: To develop and evaluate a new patient-reported outcome instrument designed to assess multidimensional fatigue domains in patients with multiple sclerosis (MS) for use in clinical practice. Methods: This study was carried out in three research stages. Stage 1 (Concept Elicitation) involved qualitative interviews (n = 19) to identify core fatigue domains based on patient experience. Stage 2 (Cognitive Interviews) consisted of interviews with 50 patients to ensure the relevance and clarity of the items. Stage 3 (Exploratory Factor Analysis) and internal consistency testing (Cronbach’s alpha) were performed on the same sample of 50 patients to examine the preliminary factor structure and reliability. Results: Concept elicitation identified lack of energy and persistent exhaustion as core symptoms. The resulting 14-item instrument covers three subdomains: Psychosocial, Physical, and Cognitive. Exploratory factor analysis supported a three-factor solution explaining 75% of the total variance (Factor 1: 28%; Factor 2: 27%; Factor 3: 20%). Internal consistency was high across all factors: Psychosocial (α = 0.923), Physical (α = 0.895), and Cognitive (α = 0.844). Conclusions: This new instrument is a conceptually robust tool that captures the interconnected nature of fatigue in multiple sclerosis (MS). These initial findings support its internal structure and conceptual foundation, providing a practical tool for symptom monitoring in neurological consultations.

Nursing Reports doi: 10.3390/nursrep16030092

Authors: Rosemary Saunders Kate Crookes Kaoru Nosaka Olivia Gallagher Jeff Hughes Caroline Bulsara Max K. Bulsara Seng Giap Marcus Ang Beverley Ewens Sue Haydon Karla Seaman Renée Graham Debra Scaini Karen Gullick Michelle Gay Christopher Etherton-Beer

Background/Objectives: Pain is a common symptom for hospitalised older adults. Pain is not always adequately assessed, which can lead to inadequate pain management and adverse patient outcomes. Thus, new technology-driven pain assessment tools have been developed; however, little is known about patients’ and families’ experiences of nurses using them in acute care. This study aimed to explore the perspectives of older adult inpatients and their families’ regarding nurses’ use of the digital technology-driven pain assessment application PainChek® Universal. Methods: A survey was undertaken as part of a stakeholder evaluation of a randomised control trial exploring the effectiveness of nurse-led volunteer support and technology-driven pain assessment in improving the outcomes of hospitalised older adults. The PainChek® Universal application was implemented on two medical wards of an acute private hospital in Western Australia as part of a larger single-centre, prospective, non-blinded, cluster-randomised control trial. This stakeholder evaluation invited older adult inpatients and their family members to participate in a survey about nurses’ use of the PainChek® Universal application for pain assessment. Results: A total of 96 inpatients and 27 family members completed the survey. Thirteen patients and nine family members provided additional feedback. Over 90% of patients and family members agreed that the use of the PainChek® Universal application was a positive addition to pain assessments, rendered no concerns, and helped nurses complete pain assessments. A total of 84% of patients and 87% of family members felt PainChek® Universal provided a more accurate pain assessment. Survey feedback related to PainChek® Universal application use, integration of technology, and need for further education. Conclusions: The findings suggest that older adults and their families recognised the benefits of nurses using a digital application for pain assessments. Technology integration in healthcare must be accompanied by patient and family education.

Nursing Reports doi: 10.3390/nursrep16030091

Authors: Richard Gray

Health research often requires human participants to complete one or more study-related tasks (fill out questionnaires, attend an interview, undergo an experimental treatment, etc [...]

Nursing Reports doi: 10.3390/nursrep16030090

Authors: Meagan Ryan Victoria Cole Judy Duchscher Richard Booth Michelle Lalonde

Digital health technologies are being used in healthcare more than ever, which has implications for the daily work of nurses. As the newest members of the nursing profession, new graduate nurses (NGNs) experience great change during the transition to practice experience. The experience of NGNs transitioning to practice while digital health technologies are being increasingly integrated is not well elucidated in the nursing literature. This proposed scoping review will address this gap and aims to explore and describe the literature involving NGNs and digital health technologies. This review will use the Joanna Briggs Institute (JBI) guidelines to search CINAHL, MEDLINE, Embase, and ERIC databases for keywords and subject headings related to the concepts of “digital health technology” and “new graduate nurses”, published between 2020 and 2026. Included articles will involve new graduate nurses with 0–12 months of experience, use digital health technology in the clinical context of nursing, and be peer-reviewed primary research. Articles will be screened and extracted using Covidence and described in line with JBI guidance and presented narratively. The findings of this scoping review will be key in positioning the transition to practice experience for NGNs in an age of digital revolution. Results will be instrumental in enhancing nursing curriculum, ensuring transition policies and procedures are supportive of developing digital health competence and assuring the delivery of better care to patients when using digital health technologies. The contribution of this review will be unique and novel in exploring NGNs and digital health, providing context for the modern experience of transition to practice.

Nursing Reports doi: 10.3390/nursrep16030089

Authors: Eunice Gatinho Pires Cristina Lavareda Baixinho Adriana Henriques Andreia Costa

Background/Objectives: Disasters have a substantial impact on health systems and populations worldwide, with increasing frequency, mortality, and economic losses associated with natural hazards. The United Nations emphasises that disasters result from the interaction between hazards, exposure, and vulnerability, requiring integrated, people-centred health responses aligned with the 2030 Agenda. However, empirical evidence describing specific nursing interventions, particularly during response and recovery phases, is limited. This study aims to analyse the fundamental nursing care interventions provided to disaster victims in the Autonomous Region of Azores, Portugal. Methods: A qualitative multiple case study was conducted using documentary analysis of the nursing records from two disaster survivors with different clinical trajectories. Data were collected between August 2023 and May 2024 through complete transcription of nursing documentation contained in the clinical files. Data analysis followed Yin’s case study methodology and was theoretically supported by the Fundamentals of Care Framework. Results: The findings indicated a predominance of interventions addressing physiological needs during the acute phase, which progressively evolved to maintenance, psychosocial support, and adaptation needs during prolonged hospitalizations. Nursing care integrates advanced technical skills with relational and person-centred interventions, including emotional support, therapeutic communication, and promotion of patient autonomy. Conclusions: Nursing practice in disaster situations should be conceptualised as integrative, person-centred care grounded in international nursing frameworks. Strengthening disaster-specific nursing education, developing phase-adapted care protocols, and promoting multicentre longitudinal research appear to play a critical role for advancing nursing care models and informing health policies in disaster-prone regions.

Nursing Reports doi: 10.3390/nursrep16030088

Authors: Ling Xu Michael Joshua Morales Marianne Biangone Thomas Hoffmann Cherry Leung

Background/Objectives: Undergraduate nursing students experience high levels of stress and depressive symptoms. This study investigated the prevalence of stress and depressive symptoms among undergraduate nursing students and analyzed the sociodemographic and interpersonal factors influencing these conditions. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, four databases (PubMed, Web of Science, Embase, and CINAHL) were searched for studies published between 2019 and 2024. Both narrative synthesis and meta-analysis were conducted to identify contributing factors and estimate the pooled prevalence rates. Prevalence rates of stress and depressive symptoms were estimated using random-effects models. Subgroup analyses were performed based on the severity of symptoms, study location, country income group, and measurement tool. Effect size, 95% confidence intervals, and p-values were reported. Results: The review included 54 studies. The prevalence of depressive symptoms and stress was 48% and 55%, respectively. Depressive symptoms were most prevalent in studies conducted in lower–middle-income countries and those using the Beck Depression Inventory II. Stress prevalence was highest in studies from upper–middle-income countries and those using the Perceived Stress Scale-10. Significant associations among sociodemographic and interpersonal factors include younger age, female gender, single status, financial issues, poor perceived health, conflicts with friends, and dissatisfaction with social activities. Conclusions: Nearly half of undergraduate nursing students from diverse settings experienced significant stress and depressive symptoms, driven by multiple sociodemographic and interpersonal factors.

Nursing Reports doi: 10.3390/nursrep16030087

Authors: Francisco Fernandes Rúben Encarnação José Alves Carla Pais-Vieira Suzinara Beatriz Soares de Lima Paulo Alves

Background/Objectives: The rapid expansion of generative artificial intelligence (AI) and large language model-based chatbots has accelerated their adoption in higher education, including nursing. This scoping review mapped the use of AI-based chatbots in nursing education, including curricular domains, pedagogical approaches, educational outcomes, and implementation challenges. Methods: A scoping review was conducted following the Joanna Briggs Institute methodology and reported in accordance with the PRISMA-ScR guideline. Searches were performed across major bibliographic databases and grey literature sources. Quantitative, qualitative, and mixed-methods studies addressing the use of AI chatbots in nursing education or professional training were included. Data were extracted using a standardized instrument and synthesized through descriptive statistics and qualitative content analysis. Results: Sixty-six studies (2019–2025) were included, with significant growth observed after 2023. Most studies employed quasi-experimental designs (37.9%) and were implemented in academic settings (83.3%). Application formats varied across online, hybrid, simulation-based, and classroom models. Reported benefits included improved learning performance, clinical reasoning, and student engagement. Key challenges involved the reliability of AI outputs, academic integrity, data protection, and limited institutional governance. Conclusions: AI-based chatbots represent promising tools to enhance nursing education, particularly when integrated into structured pedagogical strategies with active faculty supervision. Their use can support the development of clinical reasoning, student engagement, and personalized learning. However, methodological heterogeneity, ethical concerns, and governance gaps highlight the need for careful implementation and further rigorous research to ensure safe, effective, and pedagogically sound integration.

Nursing Reports doi: 10.3390/nursrep16030086

Authors: Gema López-Gutiérrez Vanesa Gutiérrez-Puertas Blanca Gómez-Guerrero Lorena Gutiérrez-Puertas

Background/Objective: Nursing students commonly use social networking sites during clinical practicums, and excessive use may interfere with their attention, performance, and training during clinical placements. However, the relationship between problematic social networking use, perceived stress, distraction, and self-management of activities during clinical practice among nursing students has not been explored in depth. The aim of this study was to analyze the relationship between problematic use of social networking sites, perceived stress, smartphone-related distraction, and self-management among nursing students during clinical practicums. Methods: A cross-sectional design was carried out. The sample consisted of 340 nursing students. Data were collected between September and November 2025 using a sociodemographic form, the WhatsApp Negative Impact Scale, Perceived Stress Scale, Distraction Smartphone Use during Clinical Practice Scale, and Self-Control and Self-Management Scale. The data were analyzed using SPSS 28. Regression analysis was performed to define the factor of the problematic use of social networks and the relationship between the scales. The STROBE Checklist was used when preparing the manuscript. Results: A positive relationship was found between problematic social networks use and perceived stress (p < 0.001) and distraction (p < 0.001), and there was a negative relationship with self-management (p < 0.001). A negative relationship was found between perceived stress and self-management (p < 0.001). After regression analysis, more problematic social network use consisted of those who spent more time daily using the smartphone (p < 0.001), had more distraction associated with smartphone use during clinical practicum (p < 0.001), had more perceived stress (p < 0.001), those whose last place performing the practicum was the hospital (p = 0.006), and those whose sex was male (p = 0.026). Conclusions: The results obtained from this study indicated an association between problematic Social networksuse and increased perceived stress and distraction, as well as decreased self-management activities during clinical practicum. In line with these findings, perceived stress was negatively associated with self-management; nursing students reporting lower perceived stress also reported a greater capacity for self-management of clinical activities.

Nursing Reports doi: 10.3390/nursrep16030085

Authors: Antonio Martínez García Iván Ortega-Deballon Juan Manuel López-Reina Roldán Andreu Martínez Hernández Martín Torralba Melero Rubén Quintero Mínguez

Introduction: Currently, REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) is an emerging technique for resuscitation in patients presenting severe pathology in hemodynamic shock refractory to conventional treatments. The REBOA technique consists of inserting a balloon through the femoral artery to temporarily occlude the aorta and thus control massive bleeding and improve perfusion of vital organs in critical situations such as hemorrhagic shock. Although it is not a definitive technique, its use buys time before the implementation of a definitive treatment when possible. This makes REBOA an ideal technique for the philosophy of out-of-hospital emergency services and more particularly in the HEMS (Helicopter Emergency Medical Service) environment. On the other hand, REBOA has been postulated as one of the basic pillars in the resuscitation of severe trauma patients with hemorrhagic shock and of the doctrine of damage-control resuscitation in non-compressible torso and lower limb hemorrhage. Objective: To evaluate the potential feasibility of REBOA implementation in patients attended by HEMS teams in Castilla-La Mancha, Spain. Method: A retrospective observational study was conducted analyzing medical and nursing reports from HEMS units between 1 January and 31 December 2023. A statistical study of the variables collected was carried out using statistical techniques appropriate to the pre-specified study variables. A descriptive analysis of the population was performed. Frequency results are expressed in absolute terms, as percentages and confidence intervals. Continuous variables are expressed as mean (SD) and median (range) according to normality test (Kolmogorov–Smirnov test). For the study of the relationship between the different variables, Chi-square or Analysis of Variance is used if they are parametric. Descriptive and inferential statistics were performed using SPSS v24. Results: A total of 103 patients (72.81% men, mean age 57.7 years) were identified as potential REBOA candidates. On arrival of the emergency services the mean SI (shock index) of the patients was 1.36 (SD +/− 0.380). On arrival at the hospital, the mean SI was 1.25 (SD +/− 0.601). Of the series, 57 (55.33%) patients suffered cardiorespiratory arrest (CRA) at some point during pre-hospital care. Of the total number of patients, 38 were patients presenting severe trauma criteria (characterized by life-threatening injuries, with RTS score ≤ 11, shock index > 0.9, or ISS ≥ 16, indicating severe physiological or anatomical alterations), of which 26 (68.4%) did not go into CRA, while 12 (31.6%) did. Of the total number of patients, 65 (63.1%) did not meet severe trauma criteria, but did present medical criteria for REBOA placement, of which 55 (53.4%) were patients who at some point during attendance presented CRA. Although the shock index showed a slight decrease after healthcare without statistical significance or relevant correlation, a highly significant association was observed between severe trauma and cardiorespiratory arrest (p < 0.001). Conclusions: It could be affirmed that it may have been feasible to implement REBOA in 4.47% (103) of the patients attended by the HEMS healthcare team of Castilla-La Mancha. This could help to reduce the morbimortality and mortality of critical patients in medical helicopters. More studies are needed to corroborate this assertion.

Nursing Reports doi: 10.3390/nursrep16030084

Authors: Pablo Buck Sainz-Rozas Laia García Fernández Marina Duque Domínguez

Background/Objectives: To identify existing evidence on strategies for standardising nursing handovers in paediatric hospital settings, given their impact on communication, safety, and quality of care. International bodies such as the WHO and The Joint Commission recommend standardisation as a key measure to reduce patient safety incidents. Methods: A scoping review was conducted in December 2022 using Medline, Cochrane Library, Scopus, and CINAHL databases. The search strategy included documents published between 2012 and 2022, in Spanish, English, Catalan, French, and/or Portuguese. We screened according to inclusion criteria (professional nurses and hospitalisation) and exclusion criteria (intensive care and medical professionals) and tabulated the results according to concurrent themes. The PRISMA-ScR guidelines were followed. Results: A total of 308 records were identified. After screening, 25 full-text articles were assessed for eligibility. Following quality appraisal, six were excluded for not meeting predefined criteria, resulting in 19 studies included in the final synthesis. The evidence mapped shows that most structured communication tools have been developed or validated in adult or medical contexts, with limited evaluation in paediatric nurse-to-nurse inpatient settings. Standardised structured communication tools used in hospital settings include SBAR, I-PASS, and Flex 11, while assessment instruments such as the Handoff CEX Scale and Handover Evaluation Scale have been applied to evaluate handover quality. Conclusions: Structured communication tools may contribute to improving information transfer and perceived quality of handover; however, paediatric nurse-specific evidence remains limited and frequently derives from non-nursing or adult contexts. Further adaptation and validation in paediatric inpatient nursing settings are required.

Nursing Reports doi: 10.3390/nursrep16030083

Authors: María Isabel Guzmán-Almagro Rosa M. Carro Pablo Izaguirre-García Francisco Félix Caballero-Díaz Miriam Leñero-Cirujano Cristina Oter-Quintana María Teresa González-Gil María Teresa Alcolea-Cosín Carmen García-García Ana Isabel Parro-Moreno

Background/Objectives: Evaluation of students in practicums is essential in their training process. Mobile technologies enable formative assessments in training, enhance feedback, and improve students’ clinical competence and self-efficacy. Nevertheless, in the absence of previous evidence, their effects on clinical learning must be evaluated with rigor and caution. We aimed to evaluate the improvement in nursing students’ clinical competence and self-efficacy during their clinical practicums using the Evaluation Nursing Student (EVENS) application. Methods: A quasi-experimental design with non-equivalent control and intervention groups was adopted. Participants were not randomly assigned. The inclusion criterion was enrolment for the Supervised Practicum II course in the Nursing degree course at University X. Students agreeing to use the EVENS application during their Supervised Practicum II were assigned to the intervention group. The primary outcomes were student competence and self-efficacy, and the secondary outcome was the usability of the application. The analysis included a comparison of the pre- and post-intervention means of the intervention and control groups using Student’s t-tests. Results: One hundred and forty-nine mostly female (n = 137, 91.9%) students participated in the study. Forty-eight were assigned to the intervention group and 101 to the control group. No statistically significant differences regarding clinical competence or self-efficacy were found between the groups. Tutors rated the application’s usability with an average of 3.8 out of 5. Conclusions: The use of the EVENS application did not improve the primary outcomes. Although it was positively received by tutors as supportive of their role in training students engaged in clinical practicums.

Nursing Reports doi: 10.3390/nursrep16030082

Authors: Laura Andrian Leal Ivaneia Alves Pereira Sobrinho Luan Gagossian Savóia José Carlos Carvalho Fabiana Faleiros Silvia Helena Henriques

Background/Objectives: This study aimed to analyze the perceptions and experiences of health professionals regarding teamwork as an interprofessional competency within the context of Intensive Care Units (ICUs) in a Brazilian public teaching hospital. Methods: This was a qualitative, exploratory study guided by a constructivist–interpretative perspective. The scenario consisted of Intensive Care Units of a public teaching hospital, which is a reference for emergency care, located in Brazil. Sampling was intentional and involved 29 professionals, most of whom, 25 (86.20%), were females, including nurses, nursing technicians, physicians, physiotherapists, and others. In order to collect data, individual semi-structured face-to-face interviews were conducted in 2025, which were audio-recorded and fully transcribed. The criterion for determining the number of participants was theoretical saturation. Data analysis followed the steps of Braun and Clarke’s thematic analysis, conducted inductively, with peer validation and the use of illustrative quotations to ensure credibility. Results: Five main categories emerged: “Understanding teamwork as an interprofessional competency,” “Factors that facilitate interprofessional teamwork,” “Factors that hinder teamwork,” “Tools used in the ICU to develop interprofessional teamwork” and “Individual actions to develop interprofessional teamwork.” The analysis revealed a central tension: although professionals discursively value interprofessional teamwork, its practical implementation is constrained by organizational and hierarchical barriers. Communication was identified as a transversal axis, functioning at times as a facilitator and at other times as a barrier. Conclusions: This study demonstrates that interprofessionality in Brazilian ICUs cannot be sustained solely through individual initiatives, but requires structured institutional strategies, such as formal collaboration protocols, interprofessional education programs, and a revision of hospital organizational culture. Furthermore, although health professionals value interprofessional teamwork, their practice still faces significant barriers. These findings may support managers’ reflection on the need to implement in-service teaching and learning strategies that facilitate interprofessional teamwork, especially those in high-technology units, thus enhancing collaborative practice in health.

Nursing Reports doi: 10.3390/nursrep16030081

Authors: Kazumi Hirano Keiko Aizawa

Background/Objectives: Evidence on postmortem grief care for family caregivers after home-based end-of-life care is limited. This scoping review aimed to map the content and effects of such interventions for adult family caregivers after home deaths. Methods: Following the Joanna Briggs Institute and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines, we searched PubMed, Cumulative Index to Nursing and Allied Health Literature, Embase, Cochrane Library, and Ichushi-Web from database inception to 31 March 2024. We included English- or Japanese-language intervention studies performed in home and community settings. “Early” grief care was defined as (i) support initiated within 6 months after the death of a loved one and (ii) interventions initiated during caregiving that assessed bereavement outcomes within 6 months after the death of a loved one. Data were charted and descriptively summarized. Results: From 4766 records, six studies were selected for the review (five randomized controlled trials and one ongoing registry trial). Interventions varied from dyadic psychological sessions integrated into specialist palliative home care (DOMUS) to brief psychoeducation, structured family-physician consultations, general-practice bereavement management with screening and stepped care, remote monitoring with nurse coaching during home hospice care, with bereavement outcomes assessed at 6 months (SCH), and an online self-help program for widowed older adults. The effects were mixed. DOMUS showed a small but significant reduction in caregiver anxiety; SCH reduced caregiver burden during caregiving and improved bereavement adjustment at 6 months. Other interventions did not demonstrate a clear advantage in outcomes over usual care. Conclusions: Early grief care after home-based end-of-life care is heterogeneous. Need-responsive multicomponent models embedded in existing home and community care pathways warrant further theory-informed evaluation.

Nursing Reports doi: 10.3390/nursrep16030080

Authors: David Luna-Aleixos Víctor M. González-Chordá Víctor Ortíz-Mallasén Irene Llagostera-Reverter Francisco H. Machancoses Águeda Cervera-Gasch Isabel Grao-Ros María Isabel Orts-Cortés María Jesús Valero-Chillerón

Background/Objectives: Pressure injuries and falls are frequent hospital adverse events. Identifying high-risk periods may help guide preventive strategies. In this exploratory study, we aimed to estimate the time from hospital admission to the occurrence of pressure injuries and/or falls and analyze its relationship with the nursing assessment at admission. Methods: A longitudinal observational study was conducted with a systematic sample of 314 adult patients admitted between January and May 2024. Nursing assessment at admission was performed using the VALENF Instrument, which integrates functional capacity, pressure injury risk, and fall risk. Survival analysis was performed to describe the temporal distribution of adverse events and compare their occurrence across nursing assessment variables using the log-rank test. Poisson Generalized Linear Models were applied to explore associated factors. Results: Nineteen adverse events were recorded (15 pressure injuries and 4 falls). Twelve of the 19 total events (63%) occurred within the first five days of admission. Patients with lower functional capacity (log-rank p < 0.001) and high-pressure injury risk (log-rank p < 0.001) according to the VALENF Instrument, showed an earlier occurrence of new pressure injuries in the Kaplan–Meier analysis. Similarly, fall risk scores (log-rank p = 0.037) obtained with the same instrument were associated with falls. Patients classified as high risk for pressure injuries showed an approximately nine-fold higher incidence rate of developing new injuries (Wald χ2, p < 0.001), while urgent admission further increased this risk more than six-fold (Wald χ2, p = 0.015). Conclusions: In this exploratory study with a limited number of events, most adverse events occurred early during hospitalization. The findings suggest that early nursing assessment using the VALENF Instrument may help stratify patients for closer monitoring early in admission, pending confirmation in larger studies.

Nursing Reports doi: 10.3390/nursrep16030079

Authors: Leonor Velez Patrícia Costa Nuno Santos Mafalda Inácio Ana Rita Figueiredo Susana Ribeiro Paulo Cruchinho Elisabete Nunes Pedro Lucas

Background: Teamwork promotes the quality and safety of care. The TeamSTEPPS® program enhances communication and teamwork among healthcare professionals and students, as well as the associated benefits. Currently, there are no studies that comprehensively explore the benefits achieved through the implementation of TeamSTEPPS® across different contexts (educational and clinical practice). Objective: This scoping review aimed to map the existing evidence on the benefits of implementing TeamSTEPPS® in educational and professional settings, emphasizing its contribution to sustainable teamwork, patient safety, and organizational learning. Methods: A scoping review was conducted following the Joanna Briggs Institute methodology and reported according to the PRISMA-ScR guidelines. Searches were performed in CINAHL Ultimate, Medline Ultimate, Scopus, the Portuguese Open Access Scientific Repository, Web of Science and Psychology and Behavioral Sciences Collection, with no time restrictions. Studies were selected based on the PCC framework, focusing on healthcare students and professionals (Population), TeamSTEPPS® implementation (Concept), and academic or clinical settings (Context). A descriptive and thematic analysis was used, enabling the identification of emerging categories and recurring patterns among the included studies. Results: Twenty-eight articles published between 2009 and 2025, predominantly from the United States of America and conducted in hospital settings, were found. The included studies comprised quantitative (n = 11), qualitative (n = 4) and quasi-experimental study (n = 13) designs. From the analysis, four thematic categories emerged: academic education, interprofessional education and simulation; professional transition and professional development; clinical implementation of the TeamSTEPPS® program in real-world settings; and patient safety culture as a central focus. Conclusions: The available evidence suggests that the TeamSTEPPS® program may strengthen teamwork and promote safe and high-quality care in both educational and clinical settings. While short-term training leads to immediate improvements in team dynamics, continuous training demonstrates greater long-term effectiveness. The consolidation of the TeamSTEPPS® methodology relies on organizational commitment, leadership engagement, and the integration of interprofessional training from the academic level onward.