Nurs. Rep., Volume 15, Issue 9 (September 2025) – 36 articles

Background: Although evidence-based practice is widely promoted in nursing, direct care nurses remain underrepresented in research activities. This study aimed to assess nurses’ attitudes toward research, their perceptions of the organizational research environment, and their levels of involvement, as well as identify key barriers and facilitators to engagement within a comprehensive healthcare system. This study also explored how racial and ethnic diversity within the nursing workforce may shape research engagement and contribute new perspectives to the field. Methods: A cross-sectional electronic survey was administered to registered nurses across 10 hospitals in a Northeast U.S. health system. The survey instrument assessed research attitudes, environment, involvement (past, present, future), and demographics. Descriptive and inferential statistics, including matched-pairs t-tests, were used to analyze responses. Results: Of 7655 invited nurses, 1094 responses were analyzed. Respondents were predominantly female (88.5%), White (56.8%), and employed full-time (87.1%) as clinical staff nurses (77.3%). While 54.8% had completed a formal research course (mainly within the past 1–3 years), informal research and statistics training were uncommon (17.4% and 5.4%, respectively). Nurses reported highly positive attitudes toward research (composite M = 2.15, SD = 0.51), especially its role in guiding practice, professional growth, and education. However, actual involvement was low. The most common current activities included practice change based on research (20.7%) and participation in committees (18.8%). Anticipated future engagement increased substantially, particularly in collaboration (+21.3%), committee participation (+20.6%), and IRB submission (+18.2%). The research environment was perceived as under-resourced, particularly in terms of protected time, funding, and mentorship. Statistically significant gaps were observed between perceived present and desired future supports (p < 0.01 for all 15 items). The Research Awareness Index revealed high rates of uncertainty about available resources (e.g., 66.1% did not know if internal funding existed). Conclusions: Nurses demonstrate strong positive attitudes and a desire to engage in research, including more advanced roles. Yet structural and informational barriers, particularly a lack of protected time, mentorship, and awareness of existing supports, limit participation. Investments in infrastructure, communication, and accessible development pathways are needed to translate nurses’ readiness into active research engagement. Implications: Institutions should prioritize making research support more visible and navigable while investing in mentorship, protected time, and user-friendly infrastructure. Addressing both facets will empower a highly motivated nursing workforce to engage in and lead practice-relevant research. Full article

Background/Objectives: During the past decade, incorporating innovative teaching strategies for active learning, such as the use of escape rooms (ERs), has effectively contributed to the acquisition of the necessary skills. This study aimed to assess students’ opinions, engagement, and gameful experience, and to analyse the impact of engagement and gameful experience on students’ opinions about ER activity. Methods: This descriptive-analytical, quantitative, and interventional cross-sectional study was conducted among first-year nursing students enrolled in the Nursing Fundamentals course. The ER activities took place in a faculty classroom. The measure included a questionnaire for assessing students’ opinions about ER activity, engagement while learning through play, and the Gameful Experience Scale. Results: The students reported very positive opinions on the outcomes of escape room activities. According to the students’ perception, solving puzzles required a high level of cognitive, emotional, physical, and other engagement. The experience of learning through play contributed to their increased enjoyment, absorption, and creative thinking, with a low level of negative effects and dominance. Enjoyment, immersion, and creative thinking during the gameful experience explained 49.0% of the variance in students’ opinions on ER activity. Conclusions: ER enabled students to consolidate knowledge from various fields within one lesson, encouraging them to be highly engaged and think creatively, giving them a sense of enjoyment in learning and motivation for further learning. Full article

Background/Objectives. Quality of nursing care (QNC) is a central concept in healthcare systems worldwide, with growing emphasis on developing reliable and contextually appropriate instruments for its assessment. Over recent decades, there has been a shift from outcome-based evaluation toward more holistic, patient-centered frameworks that consider both clinical indicators and interpersonal dimensions of care. This scoping review aimed to map the range, nature, and characteristics of self-report instruments used to assess the quality of nursing care, including their psychometric properties and contextual applications across different clinical settings. Methods. A systematic search was conducted in CINAHL Complete, MEDLINE (via PubMed), Scopus, Web of Science, and ProQuest Dissertations & Theses, alongside gray literature sources, following the Joanna Briggs Institute (JBI) methodology and PRISMA-ScR guidelines. Studies were included if they reported on the development, validation, adaptation, or application of QNC assessment tools in hospital or community nursing contexts, and were published in English, Portuguese, or Spanish. Results. Fifty-nine studies were included, spanning from 1995 to 2025. The instruments identified were predominantly structured around Donabedian’s structure-process-outcome model, and many emphasized relational domains such as empathy, communication, and respect. Tools like the Good Nursing Care Scale (GNCS), the Quality of Oncology Nursing Care Scale (QONCS), and the Karen Scales demonstrated strong internal consistency (Cronbach’s α ranging from 0.79 to 0.95). Conclusions. Organizational factors, including leadership and staffing, and predictors such as burnout and work intensity, were found to influence perceived care quality. Important gaps remain regarding longitudinal use and integration of patient-reported outcome measures. Full article

Objective: This qualitative study aimed to understand the experience of self-advocacy among patients with enterostomy and to identify the behaviors, influencing factors, and benefits of self-advocacy. Methods: A descriptive phenomenological method was used, and the study was conducted from April to June 2024. A total of 17 patients with enterostomy were interviewed, and Colaizzi’s seven-step method was used to analyze interview data. Results: Three themes and thirteen sub-themes were generated: behaviors of self-advocacy (information seeking, effective communication, support seeking, and decision making), influencing factors of self-advocacy (type of enterostomy, economic burden, caregiving burden, stigma, and social support), and benefits of self-advocacy (enhancing self-care skills, enhancing physiological–psychological–social adaptability, dietary habit modification, and peer support). Conclusions: Self-advocacy is a critical tool for overcoming challenges, meeting needs, and cultivating connected strength, and targeted interventions could be designed to improve the levels of self-advocacy and self-management. Full article

Background/Objectives: The healthcare sector is a significant source of pollution, and it is widely acknowledged that changes are required to transition to more sustainable healthcare practice. Nurses represent more than half of the sector’s workforce and are uniquely positioned to enact change. However, expertise on environmental sustainability within the nursing field is a barrier despite the topic being positively embraced by students. Methods: This research employed a cross-sectional design using an anonymous online survey with convenience sampling from registered nursing students studying online to understand their attitudes towards environmentally sustainable healthcare. Data were collected between April 2023 and January 2024 with quantitative results analysed using descriptive statistics and qualitative results using thematic analysis. Results: Results show that registered nursing students are aware of the negative environmental impact of healthcare practice, realise the importance of working more sustainably and understand the value and role of education to facilitate meaningful change in the sector. However, they called for more educational content, specifically on carbon footprints, waste management, and resource use, paired with organisational leadership support and workplace training in healthcare settings. Conclusions: Adopting these recommendations endorsed by student nurses in practice could support nurses to reduce the environmental burden of the healthcare sector and contribute to both net zero and the United Nations Sustainable Development Goals. Full article

Background/Objectives: Increases in unemployment due to the COVID-19 pandemic and doctors’ strike have intensified job-seeking stress among nursing students, contributing to academic pressure, increased stress levels, reduced participation, and a greater risk of burnout. This study investigates the relationships between job-seeking stress, academic self-efficacy, professor trust, academic engagement, and academic burnout through path analysis. Methods: A total of 496 nursing students enrolled in four-year nursing programs in South Korea participated in this study. Data were gathered using structured questionnaires from 30 August to 13 December 2021. Results: Job-seeking stress, academic self-efficacy, and professor trust significantly influenced academic engagement, accounting for 37.2% of its variance. Academic burnout was primarily explained by job-seeking stress and academic self-efficacy, with an explanatory power of 50.4%. Furthermore, academic self-efficacy played a mediating role in the relationships between job-seeking stress and both academic engagement and burnout. Conclusions: Developing interventions to enhance academic self-efficacy is crucial. Additionally, strategies should be implemented to alleviate job-seeking stress, foster academic engagement, and reduce the risk of burnout among nursing students. Full article

Background/Objectives: Preceptorship is a key aspect of clinical education for healthcare professions, including nurse practitioners (NP). Numerous studies have explored barriers and facilitators to preceptorship; however, few have used a theory-based, psychometrically sound instrument. The aim of this study was to develop and validate an instrument predicting nurse practitioner preceptorship based on the Integrated Behavioral Model (IBM). Methods: This was an instrument validation study with a longitudinal design. A pool of 82 statements that reflected constructs of the IBM was developed from the existing literature and unpublished studies. Items were evaluated for clarity and construct validity by 20 faculty members and NPs. Further refinement after administration to a small sample of NPs yielded a 60-item Likert-type survey that was sent to NPs in 20 states. A total of 154 NPs repeated the survey after 2–4 weeks to evaluate test–retest reliability. Exploratory and confirmatory factor analysis were used to establish subscales and assess internal consistency, convergent, and discriminant validity. Results: 35 items were retained in the final survey. We identified 10 subscales reflecting constructs in the IBM. All subscales had adequate internal consistency and discriminant validity. One subscale had inadequate convergent validity and test–retest reliability, while another subscale had inadequate content validity. Conclusions: The resultant Predicting Preceptorship Survey is theory-based and psychometrically sound. There is no subscale for one IBM construct, “salience.” This instrument could be used in studies of engagement in preceptorship in order to identify focus areas for interventions to increase the availability of preceptors, and to evaluate the outcomes of those interventions. Future research should include longitudinal studies of preceptorship and validation of the instrument with other professions, in other countries, and in other cultures. Full article

Background: Amidst a growing shortage of human resources for mental health, concerns persist over the mental health literacy (MHL) and readiness of nursing students to fulfil their future role as non-specialist mental healthcare providers. Methods: A cross-sectional study was conducted to assess the MHL among nursing students enrolled in a four-year nursing programme using the Mental Health Literacy Scale (MHLS) adapted and validated for primary health care workers in the South African context. Multiple regression analysis was used to determine the factors influencing MHL among the nursing students. Results: Only a third of the 220 respondents (n = 73; 33.2%) expressed interest in specialising in mental health. A one-way ANOVA revealed statistically significant differences in the MHLS scores across year levels, F(3, 216) = 3.225, p = 0.023, though Tukey post hoc analysis found no significant difference between second-year students (with mental health theory only) and third-/fourth-years (with both theoretical and clinical exposure, p = 0.295). Year of study, family history of mental illness, and career aspirations in mental health were significant predictors of MHL. While gender initially appeared significant, a sensitivity analysis suggested that this result may not be robust due to the small number of male participants. Conclusions: The absence of a significant difference in MHL among nursing students across years of study suggests limitations in how the nursing training programme integrates mental health theory with clinical practice. Nursing education stakeholders should review curricula and teaching strategies to ensure that MHL is effectively reinforced throughout training. Full article

Background/Objectives: Virtual reality (VR) is increasingly being used in educational settings, but the evidence is mixed on whether this is better for learners. This is due in part to a reliance on self-reported “liking” of the experience rather than measuring if VR more effectively improves learner engagement and conveys information. A study was designed to determine if VR would improve nursing students’ understanding of patient interactions in the clinic (n = 70). Methods: The present study measured neurologic Immersion in nursing students during a realistic patient journey in VR and in a standard two-dimensional (2D) film. After the film, participants in both conditions had the opportunity to volunteer to help other students as a measure of the behavioral impact of the experience. Results: The analysis showed that VR generated 60% more neurologic value than the 2D film, and, by increasing empathic concern, positively influenced the decision to volunteer. Conclusions: Empathy has been shown to improve patient care while reducing healthcare provider burnout, and our findings suggest that VR that sustains neurologic Immersion should have a larger place in clinician education. Full article

Background: High attrition rates among nursing students, particularly during the sophomore year, threaten the sustainability of the nursing workforce. Objectives: This study assessed structured assessment methods implemented at a School of Nursing located in northern Virginia to improve student success and reduce attrition. Methods: Interventions included a three-tier grading system (Mastery, Intermediate, and Novice), standardized rubrics, detailed instructor guidelines, remediation sessions, and medication competency practice materials. Results: Data from student and instructor feedback surveys and attrition rate comparisons between Spring 2024 and Spring 2025 revealed a reduction in overall attrition of sophomores from 23.5% to 17.3% and from 20% to 12% in the Fundamentals courses. Students reported increased engagement and confidence in foundational core skills, though complex nursing skills care posed challenges. Instructors valued the structure but questioned the suitability of certain skills for sophomores. Conclusions: These findings underscore the value of structured assessments in enhancing retention, with implications for revision of curriculum design in students’ early years of nursing education. Full article

Background/Objectives: Caring–healing modalities (CHMs), i.e., non-pharmacological, nurse-led interventions rooted in caring science, have shown promise in reducing emotional distress, while enhancing resilience. CHMs are heterogeneous, making it challenging to determine how they are formulated to build resilience, mitigate emotional distress, and explore their mechanisms of action. This scoping review mapped the literature on CHMs, including their components, targeted outcomes, and measures. Methods: This review was conceptually driven by Watson’s Theory of Human Caring, followed the JBI methodology, and reported according to the PRISMA-ScR. Experimental studies, systematic reviews, opinion pieces, and the gray literature on CHMs for emotional distress and resilience delivered to persons with cancer, written in English, were considered. No date or setting limits were applied. Eleven databases (e.g., PubMed and CINAHL Full Text), were searched. Two independent reviewers screened, selected, and extracted the data. The results were interpreted using Watson’s theory. Results: We included 16 records (2016–2025), mostly from the United States (n = 4; 25%) and China (n = 6; 37.5%). The CHMs mainly targeted persons with breast cancer. The CHMs were categorized into four groups: mindfulness-based, group-based, expressive, and educational. Common active ingredients included peer support and group discussions. Dedicated healing spaces facilitated CHMs delivery; mode of delivery and dose varied widely. Conclusions: This review provides a foundational understanding of CHMs as a caring-based, holistic approach to cancer survivorship. Findings identify CHMs’ key components, including active ingredients, mode of delivery, and dose. Future studies should ensure diversity in terms of cancer type, as most existing studies focused on breast cancer. Full article

Background: Gamification may enhance engagement and higher-order learning in health-care profession education, but evidence from undergraduate nursing programs—particularly in the Middle East—is limited. We evaluated whether integrating structured gamified activities into an anatomy and physiology course improves class engagement and knowledge-based critical thinking. Methods: In this pragmatic, nonrandomized, section-allocated quasi-experimental study at a single Saudi institution, 121 first-year female nursing students were assigned by existing cohorts to traditional instruction (control; n = 61) or instruction enhanced with gamified elements (intervention; n = 60) groups. The intervention (introduced mid-semester) comprised time-limited competitive quizzing with immediate feedback and aligned puzzle tasks. Outcomes were measured at baseline, mid-semester, and end-semester using a four-item Class Engagement Rubric (CER; scale 1–5) and a 40-item high-cognitive multiple-choice (MCQ) assessment mapped to course objectives. Analyses used paired and independent t-tests with effect sizes and 95% confidence intervals. Results: No attrition occurred. From baseline to end-semester, the intervention group had a mean CER increase of 0.59 points (95% CI, 0.42 to 0.76; p < 0.001)—approximately a 15% relative gain—and a mean MCQ increase of 0.30 points (95% CI, 0.18 to 0.42; p < 0.001), an ~8% relative gain. The control group showed no material change over the same interval. Between-group differences in change favored the intervention across CER items and for the MCQ outcome. Semester grade-point average did not differ significantly between groups (p = 0.055). Conclusions: Embedding a brief, structured gamification package within an undergraduate nursing anatomy and physiology course was associated with measurable improvements in classroom engagement and modest gains in knowledge-based critical thinking, with no detectable effect on overall semester GPA. Given the nonrandomized, single-site design, causal inference is limited. Multi-site randomized trials using validated critical-thinking instruments are warranted to confirm effectiveness and define dose, durability, and generalizability. Full article

Background/Objectives: Patients receiving professional homecare often require support in managing their medication. In Switzerland’s legislative system, medication logistics (ordering, delivery, pickup, storage) are regulated differently by each canton, making it challenging for professional homecare organisations to comply with provisions efficiently. The present study aimed to analyse the current international literature, Switzerland’s regulations about medication logistics for professional homecare, and the current practices. Methods: We conducted a systematic literature review of the PubMed, Embase and CINAHL databases to identify existing international research on medication logistics by professional homecare organisations published until February 2024. The results of a structured online survey on medication logistics by professional homecare organisations in Switzerland’s German-speaking regions were compared against the medication regulations currently in place. Results: Ten studies were included in the review. The medication logistics processes of homecare organisations have rarely been researched, especially short-term and long-term storage. Few regulations cover medication logistics in Switzerland’s legislation, and they are often formulated non-specifically and focus on inpatient facilities. Some cantons allow centralised medication storage, others prohibit it. Only one canton explicitly permits short-term medication storage under simplified requirements. We evaluated the answers of 105 homecare organisations responding to our survey; 73.7% (73/99) of them nevertheless stored medications in the short term before bringing them to patients’ homes. Switzerland’s professional homecare organisations generally fulfil their legal requirements well. There is potential to improve the formulation of standard operating procedures for each step of the homecare medication use process, especially for cleaning medication storage sites (12/31, 38.7%) and short-term storage processes (29/56, 51.8%). Conclusions: There are few studies or guidelines on professional homecare organisations’ medication logistics, and they generally fail to address medication storage. Short-term medication storage is common despite most cantonal requirements being strict or prohibiting it, or not regulating it all. There is an urgent need for unambiguous, practice-oriented recommendations specific to homecare, especially for short-term medication storage. Full article

Background/Objectives: In recent years, the use of gamification has been growing in health education. In undergraduate nursing programs, it aims to enhance motivation, engagement, knowledge retention, and professional competencies. However, the evidence often combining nursing students with other disciplines or focusing on specific tools rather than the broader concept. This systematic review will synthesize the impact of gamification strategies on educational outcomes in undergraduate nursing education. Methods: This protocol was written according to PRISMA-P guidelines and is registered in PROSPERO (CRD420251117719). Eligible studies will include randomized controlled trials, quasi-experimental, and observational designs involving undergraduate nursing students exposed to gamification interventions in classroom, online, or clinical training settings. Comparators may include traditional lecture-based instruction or other non-gamified methods. We will search the PubMed, CINAHL, PsycINFO, Web of Science, Scopus, and Google Scholar databases, covering January 2010 to July 2025, without language restrictions. Two reviewers will independently screen studies, extract data, and assess risk of bias using Cochrane RoB-2, ROBINS-I, and JBI Critical Appraisal Tools. Where possible, a meta-analysis will be conducted; otherwise, findings will be synthesized narratively. Results: Not applicable; this is a protocol. Findings will be synthesized as specified in the Methods. Conclusions: This review will provide a comprehensive synthesis of gamification’s effectiveness in undergraduate nursing education, identifying the most effective strategies and the contexts in which they perform best. Full article

Background: Digital health literacy is crucial for navigating social media as a primary health information source. However, its interactive and unregulated nature fosters misinformation, requiring critical evaluation skills. Existing tools assess general internet use, but no validated instrument measures competencies specific to social media. This study aimed to adapt and validate the eHealth Literacy Scale (eHEALS) for this context. Methods: A content validation process was conducted with 33 experts, who evaluated the clarity, coherence, and relevance of the adapted questionnaire using item-level (I-CVI) and scale-level (S-CVI) content validity indices. A pilot study was then carried out with 250 participants to assess the instrument’s reliability and feasibility, measured through Cronbach’s alpha and McDonald’s Omega. Results: The adapted eHEALS demonstrated excellent content validity (S-CVI > 0.90) and high internal consistency (Cronbach’s α = 0.92; McDonald’s Ω = 0.92). The tool effectively captures key competencies for evaluating and applying health information in social media contexts, with exploratory factor analysis confirming a unidimensional structure that explained over 60% of the variance, supporting its robustness for use in population-based studies. Conclusions: This validated instrument provides a reliable method for assessing digital health literacy in social media, supporting the development of educational interventions to enhance critical appraisal skills and mitigate the impact of misinformation. Full article

Background: Globally, there is a growing demand for the adoption of electronic health systems and the transition toward digital processes within healthcare organizations. Electronic Medical Records (EMRs) play a vital role in enhancing documentation accuracy, improving healthcare delivery, and minimizing medical errors. However, limited research has explored nurses’ perceptions of EMR effectiveness within Ministry of Health hospitals in Jeddah City. Methods: A quantitative descriptive cross-sectional design was employed in four governmental hospitals affiliated with the Ministry of Health in Jeddah. A convenience sampling technique was used to recruit 911 full-time registered nurses from inpatient and outpatient departments. Data was collected through an electronic self-administered questionnaire evaluating EMR use, system quality, and user satisfaction. Descriptive and inferential statistical analyses were conducted using SPSS version 26. Results: The global EMR score (82%) reflected a high level of acceptance and integration of EMR systems among the nurses surveyed. The use of order entry received the highest mean score (84.8%), indicating that nurses find EMRs particularly effective in streamlining administrative and clinical tasks, such as medication orders and care plans. The strong correlation between system quality and user satisfaction (rs = 0.911) underscores the importance of well-designed EMRs in fostering trust and confidence among clinical users. Conclusions: The findings indicate that nurses perceive EMRs as effective tools for improving documentation, care coordination, and workflow efficiency. This study recommends the establishment of structured feedback mechanisms that enable nurses to report issues, suggest improvements, and share success stories—thereby fostering a culture of continuous system enhancement. Full article

Background/Objectives: Older adults with cancer are at high risk of developing delirium. Comprehensive geriatric assessment (CGA) is a fundamental tool for prioritizing problems and establishing appropriate interventions in older patients. This study aimed to identify risk factors for delirium through a CGA in older adults receiving palliative cancer care in hospital. Methods: This longitudinal observational study included people aged 65 years or over who were hospitalized in medical wards with an advanced stage of cancer. Clinicians performed a CGA and screened for delirium using the Confusion Assessment Method (CAM). Diagnosis of delirium was based on criteria set out in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V). We calculated odds ratios (ORs) with 95% confidence intervals (CIs) to compare different variables in people with versus without delirium. Results: The study included 105 participants, of whom 67 (63.81%) developed delirium during follow-up. The mean age was 71.33 years in the delirium group and 72.24 years in the non-delirium group. Risk factors for delirium were dysphagia (OR 2.45, 95% CI 1.01–5.99; p = 0.045), urinary catheterization (OR 2.97, 95% CI 1.09–8.13; p = 0.029), and having at least one delirium episode in the last year (OR 5.68, 95% CI 1.97–16.34; p = 0.001). The predictive model showed that older male cancer patients with a urinary catheter and dysphagia are most likely to develop delirium in hospital (area under the curve [AUC] = 0.679, 95% CI 0.577–0.780; p = 0.002). Conclusions: The prevention and effective management of delirium require a person-centered, interdisciplinary approach that considers both clinical and psychosocial aspects. Including variables such as male sex, dysphagia, and urinary catheterization in delirium risk assessment enables more comprehensive and personalized management. Full article

Background/Objectives: Informal caregivers play an important role in the palliative care of terminally ill family members at home. However, they often lack sufficient professional support, particularly in coping with emotional, spiritual, and practical challenges. This study aimed to explore caregivers’ experiences of providing care to a terminally ill family member at home. Methods: A qualitative approach was used to collect information from informal caregivers. Data were collected through interviews, and thematic analysis was used to identify the main challenges, coping mechanisms, and perceptions related to palliative care. Results: The study resulted in three themes: Involvement of professionals; The reality and dignity of death, and Life after death. Caregivers often associate palliative care exclusively with the last days of life, leading to delayed involvement of the mobile palliative care team. They stated that they preferred home care to hospital care and associated this with more positive experiences at the end of life. However, many reported feelings of loneliness and emotional distress, indicating a lack of appropriate psychological support. Spiritual care is often confused with religious practices, indicating a need for further education. Conclusions: The early involvement of mobile palliative care teams improves coping, facilitates a more humane dying process at home, and can reduce the emotional burden on caregivers. Full article

Screening for diabetes-specific distress should be considered a standard component of diabetes management. This study aimed to evaluate the psychometric properties of the Serbian adaptation of the Problem Areas in Diabetes—Teen Version (PAID-T). Methods: A multicentre, validation, cross-sectional study was conducted with 374 adolescents (aged 13–18 years) diagnosed with type 1 diabetes (T1D), all of whom completed the Serbian version of the PAID-T. The psychometric evaluation included assessments of construct validity through exploratory (EFA, first subsample, n = 140) and confirmatory (CFA, second subsample, n = 234) factor analyses, as well as examinations of concurrent and convergent validity. Reliability was evaluated using measures of internal consistency and test–retest stability (n = 289). Results: Factor analyses indicated some multidimensionality; however, the high correlations between factors in the three-factor model and the optimal fit of the hierarchical three-factor model with a single second-order factor supported the interpretation that the PAID-T measures a unified construct, with satisfactory fit indices (CFI = 0.95; TLI = 0.93; RMSEA = 0.08; SRMR = 0.05). Concurrent validity testing demonstrated gender-based differences in adolescents’ perceptions of the emotional burden of diabetes (W = 19.718, p = 0.03, small effect size = 0.11). Convergent validity analyses showed that adolescents who were non-adherent to treatment (W = 11.390, p = 0.01, small effect size = 0.13) or experienced difficulties managing diabetes at school (W = 16.333, p < 0.001, small effect size = 0.16) reported significantly higher levels of diabetes-specific distress. A significant negative correlation was also observed between PAID-T scores and perceived social support (ρ = −0.24, p < 0.001). Importantly, Serbian adolescents with T1D reported mean PAID-T scores close to the cutoff point of 44, indicating clinically relevant levels of distress. The Serbian version demonstrated strong internal consistency (Cronbach’s α = 0.92; McDonald’s ω = 0.93) and excellent test–retest reliability (ICC = 0.99, 95% CI), confirming stability over time. Conclusions: The Serbian adaptation of the PAID-T demonstrated strong validity and reliability, supporting its use as a robust tool for assessing self-reported diabetes-specific distress in adolescents. Notably, the mean PAID-T scores in Serbian adolescents with T1D were close to the established cutoff point of 44, underscoring the clinical relevance of routine screening in this population. The early identification of diabetes distress can enable nurses and other members of the multidisciplinary healthcare team to deliver tailored interventions, ultimately improving psychological well-being and health outcomes. Full article

Background: Stroke survivors and their family caregivers face substantial burdens resulting from a complex interplay of clinical, functional, and psychosocial factors. Community-based resources and social networking are critical for alleviating caregiver burden and improving outcomes for both caregivers and stroke survivors. Objectives: To assess the Saudi population’s readiness to use social platforms for stroke survivors’ recovery and caregiver support. Methods: A cross-sectional descriptive design was employed between March and June 2025 to collect data from community-dwelling individuals using sociodemographic and Technology Readiness Index (TRI) questionnaires. Results: A convenience sample of 576 participants was enrolled in this study. Overall, the participants showed a high level of technology readiness, with a total TRI mean score of M = 3.65, SD = 0.86. Optimism had the highest mean score, followed by innovativeness, insecurity, and discomfort. Significant differences in technology readiness were identified based on age, educational level, employment status, familiarity with modern technology, and healthcare provider status. Conclusions: This study demonstrates a high level of technological readiness across the Saudi population, indicating strong potential for integrating social connection platforms into stroke recovery and caregiver support. These findings align with Saudi Arabia’s Vision 2030 goals for digital transformation in the healthcare sector. Future research should focus on conducting feasibility studies to better understand the desirable features of e-health services and digital solutions within the Saudi community. Full article

Background: The Nursing Work Environment (NWE) plays a critical role in determining the quality of care, staff well-being, and organizational performance, particularly in oncology settings. Despite increasing attention, a comprehensive synthesis of organizational factors shaping oncology NWEs has been lacking. This scoping review aimed to describe the key features of oncology NWEs and to explore the outcomes associated with these characteristics. Methods: A scoping review was conducted following the Joanna Briggs Institute guidelines. Peer-reviewed studies published in English or Italian were included without time restrictions. Literature searches were performed in MEDLINE via PubMed, CINAHL, and Scopus between January and April 2025. Results: Twenty studies met the inclusion criteria. Key organizational characteristics of oncology NWEs were grouped into the following four domains: leadership and organizational support; workload and resource availability; ethical climate and collegial relationships; and physical and structural conditions of care settings. Across the studies, a positive NWE was frequently reported to be associated with improved nurse-related outcomes and, to a lesser extent, with patient-related outcomes. However, these associations should be interpreted with caution due to the heterogeneity of contexts and the predominance of cross-sectional designs. Conclusions: The NWE is a strategic element in delivering effective, safe, and sustainable oncology care. Practical actions for nurse managers and healthcare leaders include implementing leadership training programs, ensuring adequate staffing and resource allocation, fostering open communication, and promoting interdisciplinary collaboration. These measures are essential to protect staff well-being and guarantee high-quality, patient-centered care. Full article

Background/objectives: Falls are the most common adverse events in hospitals. This study aimed to estimate excess hospitalisation costs attributable to inpatient falls, using Diagnosis-Related Group (DRG) relative weights as a proxy for resource consumption. Methods: Case–control study. Cases included patients who had sustained a fall during hospitalisation between 2020 and 2022 in 19 inpatient units. Controls were selected with matching technique based on age and admission period. Diagnosis-Related Groups and their resource consumption and cost estimators (relative weights) were provided by the Hospital’s Coding Unit. Results: A total of 613 falls were analysed against 623 controls. The Diagnosis-Related Group ‘Lower limb amputation except toes’ was associated with a fourfold higher risk of falling compared to others. Five more were identified in which the case group incurred significantly higher costs than the control group. These included three surgical Diagnosis-Related Group, ‘Urethral and transurethral procedures’, ‘Heart valve procedures without acute myocardial infarction or complex diagnosis’, and ‘Arterial procedures on the lower limb’, and two medical, ‘Heart failure’ and ‘Major pulmonary infections and inflammations’. Conclusions/Implications for practice: Identifying Diagnosis-Related Groups in which falls are associated with increased hospitalisation costs allows for a comprehensive assessment of the process, taking into account resource consumption and the clinical characteristics of hospitalised patients. These findings will enable nurses to develop targeted strategies to enhance the safety of hospitalised patients that contribute to the sustainability of the healthcare system. Full article

Background/Objectives: Effective clinical handover is a critical component of nursing care, particularly in mental health settings, where the transfer of clinical and behavioral information is essential for both patients’ and health personnel’s safety. Gamification has emerged as a promising strategy to enhance clinical education, yet few interventions have focused specifically on mental health care contexts. This study aimed to evaluate the effectiveness of a serious game designed to teach the SBAR (Situation, Background, Assessment, Recommendation) handover framework to undergraduate nursing students through a psychiatric care unit scenario. Methods: A quasi-experimental pre–post design was employed with a convenience sample of 48 nursing students from a Northern Italian university. Participants completed a test assessing their ability to organize clinical information according to the SBAR model before and after the game intervention. Students’ experience was assessed using the Player Experience Inventory. Results: A statistically significant improvement in SBAR application was observed post-intervention. The majority of students reported a positive experience across PXI domains such as Meaning, Challenge, Progress Feedback, and Enjoyment. Comparisons with a previously validated video-based nursing serious game showed a consistent overall pattern in response trends. Conclusions: The SG was an effective and engaging educational tool for improving structured handover skills in nursing students. Gamification may represent a valuable complement to traditional instruction in nursing education, especially in high-communication clinical areas such as mental health. Further research is needed to assess long-term retention and to explore more immersive formats. Full article

Background: Rare diseases affect fewer than 1 in 2000 people, but collectively, they impact millions. Their diagnosis and management present challenges due to low prevalence, clinical heterogeneity, and a lack of standardized protocols. Nurses play a key role in assisting and caring for these patients by providing direct care, emotional support, and health education. Objective: The objective of this systematic review is to update the existing knowledge on nurses’ level of understanding regarding rare diseases, as a decline in their training can compromise the quality of care and access to early detection. Methodology: A bibliographic search was conducted in Scopus, PubMed, CINAHL, SciELO, and Cochrane Library, selecting studies published between 2014 and 2024 on rare disease knowledge. The PRISMA model was followed, and the review was registered with PROSPERO under code CRD42024580656. Result: Ultimately, 24 studies were included. The main results showed a significant gap in nursing education concerning rare diseases. Conclusions: Continuous education, telemedicine, and the integration of health technologies were highlighted as improving competencies in rare diseases. Therefore, it is a priority to increase nursing training in rare diseases at all levels. Full article

Background: Sense of coherence constitutes a significant personal resource that underpins the harmonious professional functioning of nurses employed in psychiatric inpatient wards. It serves as a protective factor, enabling effective coping with the psychophysical burden arising from a demanding and stress-inducing work environment, while also supporting the maintenance of a high level of job satisfaction. Regular assessment of the sense of coherence among psychiatric nursing staff is essential for the early identification of individuals at risk of developing occupational burnout. The aim of the present study was to determine the relationship between the level of sense of coherence and the degree of occupational burnout among nurses working in inpatient psychiatric units. Methods: The study employed a cross-sectional design and utilized standardized psychometric instruments, including The Sense of Coherence Questionnaire (SOC-29) to assess the level of coherence, and the Maslach Burnout Inventory (MBI) to measure occupational burnout. Additionally, a self-developed questionnaire was used to collect sociodemographic data. The research was conducted in five psychiatric hospitals in Poland between January and June 2023. The sample consisted of 555 nurses (449 women and 106 men) employed in inpatient psychiatric wards. Statistical analyses included descriptive statistics, Pearson’s correlation coefficients to examine relationships between variables, and multiple linear regression to identify predictors of burnout dimensions. Significance level set at p < 0.05. Results: The mean global sense of coherence score among psychiatric nurses was 124.68 (SD = 45.81), with manageability scoring highest among subscales (43.83, SD = 16.28). Average occupational burnout scores were emotional exhaustion 28.75 (SD = 16.39), depersonalization 13.55 (SD = 9.71), and reduced personal accomplishment 23.61 (SD = 11.11). Significant negative correlations were found between sense of coherence (and its components) and all burnout dimensions (p < 0.001). Manageability was the strongest predictor of lower emotional exhaustion (β = −0.73), depersonalization (β = −0.65), and reduced personal accomplishment (β = −0.65), while meaningfulness predicted depersonalization (β = 0.37, p = 0.012). These results indicate that higher sense of coherence, especially manageability, is linked to reduced burnout among psychiatric nurses. Conclusions: The study revealed significant negative associations between sense of coherence and all dimensions of occupational burnout, with manageability emerging as the strongest protective factor. Nurses with higher levels of sense of coherence reported lower emotional exhaustion, depersonalization, and reduced personal accomplishment. These findings highlight the importance of incorporating sense of coherence assessment into strategies for identifying individuals at increased risk of burnout. Full article

Background/objectives: Dementia is the most common cause for long-term care placement for people over the age of 65 years. The decision and the transition are often very difficult for families and the type and timing of effective support not well understood. In this exploratory study, we aimed to gain a better understanding of the experience of this transition to a long-term care setting and its impact on social connections. Methods: We conducted virtual in-depth interviews with a sample of spouses (N = 5) who had identified their partner’s move to a nursing home as particularly distressing. Interview data were analyzed using thematic analysis. Results: We identified that the transition process involved a particular disruption for dyads’ social health, although there was rarely a consideration in planning or support provision. For the person living with dementia, the unacknowledged loss of their social world reinforced their social death. Their grieving partner was explicitly and implicitly encouraged to recover a new social world as a means of healing from the loss. Conclusions: Our findings reinforce the need for evidence-informed support during the transition to long-term care for someone living with dementia and their partner. Full article

Introduction: Eliminating mother-to-child transmission (EMTCT) of HIV is a global health priority to ensure that no child is born with HIV. When EMTCT services are underutilized, mothers and babies face greater risks, including the vertical transmission of HIV and higher rates of maternal and neonatal mortality. Despite ongoing efforts, many women worldwide still struggle to access and use these vital services. Objective: This study sought to explore barriers and facilitators to the elimination of mother-to-child transmission services among pregnant and breastfeeding women (PBFW) in Gauteng province, South Africa. Methods: A qualitative, explorative, and descriptive research design was used. Convenience and purposive sampling were used to select participants. The study population consisted of PBFW aged 18 years or above who were utilizing EMTCT services. Data was collected through in-depth face-to-face individual interviews with participants. A semi-structured interview guide was used to collect data until data saturation was reached after interviewing 25 participants. Data were analyzed using thematic analysis (Tesch’s open coding method). Trustworthiness and ethical principles were ensured. Results: Four main themes emerged from the data analyzed, namely, barriers associated with EMTCT service utilization, facility-based strategies to improve EMTCT service uptake, community support for enhancing EMTCT engagement, and the role of partner support in service utilization, each with linked sub-themes. This study found that health education about EMTCT, along with community awareness and involvement, encourages the target group to utilize these services. Conclusions: Increasing women’s use of EMTCT services is an important step toward eliminating MTCT and increasing the health and well-being of mothers and their children. Addressing numerous barriers to receiving these services, as well as implementing targeted measures, can help ensure that all women gain access to the care and support that they require to safeguard their families from HIV. Full article

Background/Objectives: The transition from theoretical knowledge to clinical practice poses significant challenges for nursing students globally. This critical period requires comprehensive educational support to build confidence and competence. While short-term preparatory courses have shown promise internationally, their effectiveness within the Saudi Arabian context remains understudied. This study aimed to evaluate nursing students’ satisfaction and self-confidence following participation in short-term preparatory courses conducted before clinical placements at Taibah University, Saudi Arabia. Methods: A descriptive cross-sectional study was conducted from February to April 2025. Data were collected from 117 undergraduate nursing students (response rate: 80.7%) using a validated questionnaire adapted from the National League for Nursing’s Student Satisfaction and Self-Confidence in Learning instrument. The preparatory courses included nursing care plan development, hospital orientation, and infection control procedures delivered over two weeks. Statistical analysis included descriptive statistics and Pearson correlation analysis. Results: Students reported high levels of satisfaction (mean = 4.29 ± 0.92) and self-confidence (mean = 4.31 ± 0.81) scores. The highest satisfaction was with instructor effectiveness (mean = 4.31 ± 1.05) and teaching methods (mean = 4.32 ± 1.01). Students demonstrated strong confidence in personal learning responsibility (mean = 4.44 ± 0.88) and skill development (mean = 4.32 ± 0.95). A strong positive correlation existed between satisfaction and self-confidence (r = 0.79, p < 0.001). Conclusions: Short-term preparatory courses effectively enhanced nursing students’ satisfaction and self-confidence in the Saudi Arabian context. The strong correlation between these constructions suggests that educational interventions improving one dimension is likely to benefit the other. These findings support integrating structured preparatory programs into nursing curricula to facilitate successful clinical transitions. Full article

Background: Empathy is essential for enhancing care quality, making its understanding and predictors crucial for healthcare education. Objective: To investigate empathy evolution and its predictors among first-year health professional students at a university in Albania. Methods: A longitudinal cohort study was conducted on a total of 206 participants (78.2% female, mean age 18.4 years), with empathy assessed at baseline and program completion using the Jefferson Scale of Empathy-Health Professional Students. Results: The findings revealed stable empathy levels overall (p = 0.369), with no significant differences between nursing and other students. Approximately 52.9% experienced empathy gains, while 44.7% experienced losses, yielding an average score change of +0.7 (SD = 14.9). A younger age and lower baseline empathy scores were significant predictors of empathy gains, as shown by regression analyses. Conclusions: The study highlights a dual empathy trajectory among students and emphasizes a person-centered approach to health professional education to foster empathy development. Full article

Background: China’s rapidly ageing population faces a double burden of social frailty (SF) and social isolation (SI), both of which accelerate functional decline and increase healthcare use. Clarifying their interplay is essential for nurses, who are often the first to assess and intervene in older adults’ social health. Method: In a cross-sectional study, 451 community-dwelling adults aged ≥ 60 years (median = 71) completed the HALFT Social Frailty Scale and the Social Isolation Scale for Older Adults. A mixed graphical model based on Spearman correlations mapped symptom-level associations between SF and SI and identified central nodes. Result: SF was present in 22.8% of participants, and the median SI score was 13 (IQR = 9–16). The strongest edge linked “inability to help others” (SF1) with reduced “face-to-face contact frequency” (SI1) (edge weight = 1.85). Central nodes were “lack of social participation” (SI2), “sense of belonging” (SI4), and “lack of someone to talk to” (SF5), indicating key points where SF and SI converge. Conclusions: The tight network connecting SF and SI suggests that nursing assessments should screen for both constructs simultaneously. Interventions that increase social participation, foster belonging, and create opportunities for reciprocal helping may mitigate both syndromes, supporting healthier ageing and reducing downstream healthcare utilization. Full article