Search Results (263)

Background: Pain is one of the most common complaints among all age groups. Adult patients can express pain more clearly. Unfortunately, pediatric patients cannot perform this. This study aimed to assess the extent of knowledge of healthcare providers regarding acute pediatric pain management. Methods: A cross-sectional study was conducted utilizing the modified Knowledge and Attitude Survey Regarding Pain (KASRP) questionnaire through face-to-face interviews. The modified version included 34 questions (24 true/false questions and 10 MCQs). This study targeted anesthesiologists, pediatricians, and pediatric nurses through interviews. Demographic and educational data were analyzed as factors affecting the results of the KASRP questionnaire. The total score was classified as poor, fair, or good. Results: A total of 137 participants were enrolled in this study. The mean age was 31.8 years, and of the participants, 62.8% were women, 30.0% were anesthesia physicians, 25.5% were pediatric physicians, and 44.5% were pediatric nurses. The participants scored an average of 20.7 out of 34. Performance was categorized as poor, fair, or good, with 22.6%, 64.2% and 13.2% of participants falling into each category, respectively. The mean score of correct responses was higher for anesthesiologists (p = 0.0001). Specialists achieved higher mean scores than residents. Completion of pediatric pain management courses and the use of assessment tools were linked to higher performance. Conclusions: Pediatric nurses achieved lower scores for knowledge of acute pediatric pain management than physicians. Anesthesiologists achieved the highest score, probably because of their training in pain management. All healthcare providers should attend pain management courses. Full article

Background/Objectives: Workplace violence remains an important vocational psycho-social risk for nurses employed in the emergency department (ED). We investigated the characteristics of workplace violence against ED nurses, and associations with self-assessed resilience, socio-demographic and vocational parameters, including turnover intention. Methods: ED nurses employed in all public hospitals in the Republic of Cyprus (RC) participated. After obtaining informed consent, data were collected using census sampling (January–June 2024) via the translated 2016 Italian National Survey on Violence towards Emergency Nurses Questionnaire (QuINVIP16) for investigating workplace violence characteristics, and the Connor-Davidson Resilience Scale (CD-RISC-25) for assessing self-perceived resilience. Results: A total of 132 nurses (53.0% response rate) participated. Verbal violence was reported by 70.5% to 92.4% of participants. Long waiting times, overcrowded EDs, and perception of inadequate attention from healthcare professionals were reported as the primary triggers for violence towards participants by patients/visitors. One-third of participants reported that violence-reporting systems were unclear, while 1 out of 4 reported inadequate safety measures against violence. Participants with higher scores of self-perceived resilience were less likely to report turnover intention due to workplace violence (p < 0.001), while those with lower self-perceived resilience reported a significant decrease in work motivation (p = 0.005). Those who experienced decreased work motivation after exposure to a violent episode were more likely to consider a) leaving the profession [OR (95%CI): 79.1(17.7–353.2); p < 0.01], and b) moving to a different work setting [OR (95%CI): 17.0(3.8–76.2); p < 0.01], and actually applying to be transferred to a different work setting [OR (95%CI): 19.6(4.2–91.5); p < 0.01]. Moreover, those who had not attended communication skills training were 4 times more likely to consider leaving the profession following exposure to violence [OR (95%CI): 4.2(1.1–16.2); p = 0.04]. Conclusions: This study is among the few to link workplace violence with both resilience and actual turnover behaviors among emergency nurses, in general and particularly in the post-pandemic era. By showing how personal resilience in the face of violence is shaped by organizational support, such as reporting systems and training, the present findings move beyond individuals-level explanations, and highlight workplace violence as a systematic administrative challenge. This insight represents an important advance in current knowledge, and calls for multifaceted interventions that strengthen both personal and institutional capacity to address violence. Full article

Sleep disturbances and shift work are associated with increased cardiovascular risk, possibly through disruptions in endothelial and hemostatic function. While prior studies link acute sleep deprivation to vascular dysfunction, the impact of chronic sleep quality and circadian misalignment on endothelial health in healthy individuals, particularly shift workers, remains underexplored. The aim of this study was to examine the association between objectively measured sleep quality and endothelial/hemostatic function in healthy female hospital nurses, comparing shift and day workers, and considering time-of-day variation. In this repeated-measures study, 100 female nurses (51 shift, 49 day workers) aged 25–50 wore actigraphy devices for 7–14 days to assess total sleep time (TST), sleep efficiency (SEF), and wake after sleep onset (WASO). Endothelial function was measured using EndoPAT (Reactive Hyperemia Index—RHI). Hemostatic markers included plasminogen activator inhibitor-1 (PAI-1), von Willebrand factor (VWF), heparanase and heparanase procoagulant activity assessed by ELISA, and chromogenic assays in morning and evening. TST was not associated with any vascular outcomes. Poor sleep quality (low SEF, high WASO) was significantly associated with reduced RHI and elevated PAI-1 level, heparanase level, and heparanase procoagulant activity levels. Regression models revealed significant main effects of SEF and WASO on endothelial and coagulation markers, with some interactions depending on shift type and time of measurement. No significant associations were found for VWF. Impaired sleep quality, but not sleep duration, is associated with endothelial dysfunction and procoagulant activation, particularly among shift-working nurses. These findings suggest that sleep quality may play a critical role in vascular health and support the use of sleep-based interventions to reduce cardiovascular risk in shift-working populations. Full article

Background: Nurse-manager competencies shape workforce stability, yet role-based perception gaps between managers and staff may influence staff nurses’ turnover cognitions. Objectives: To (1) compare nurse managers’ self-ratings with staff nurses’ ratings of the same managers on the Nurse Manager Competency Inventory (NMCI); (2) compare both groups’ perceptions of staff nurses’ turnover intention (EMTIS); (3) examine domain-specific links between perceived competencies and perceived turnover intention; and (4) explore demographic influences (age, education, experience) on these perceptions. Methods: Cross-sectional dual-rater study with 225 staff nurses and 171 nurse managers in two tertiary hospitals in Saudi Arabia. Data were collected from August to November 2024. Managers completed NMCI self-ratings, and staff nurses rated their managers on the same NMCI domains; both groups rated staff nurses’ turnover intention using EMTIS. Between-group differences were tested with one-way ANOVA (two-tailed α = 0.05), and associations were examined with Pearson’s r (95% CIs). Findings: Managers consistently rated themselves higher than staff rated them across all nine NMCI domains; the largest descriptive gaps were in Promoting Staff Retention, Recruit Staff, Perform Supervisory Responsibilities, and Facilitate Staff Development (e.g., overall NMCI: managers M = 3.67, SD = 0.61 vs. staff M = 3.04, SD = 0.74; F = 0.114, p = 0.73)with comparatively smaller divergence for Ensure Patient Safety and Quality. Managers and staff did not differ significantly on EMTIS (overall EMTIS: managers M = 3.16, SD = 1.28 vs. staff M = 3.00, SD = 1.15; F = 21.32, p = 0.173). Specific competency domains—retention, supervision, staff development, safety/quality leadership, and quality improvement—showed small inverse correlations with EMTIS facets (typical r ≈ −0.11 to −0.19; p < 0.05), whereas the global NMCI–overall EMTIS correlation was non-significant (r = −0.077, p = 0.124). Effect sizes were modest and should be interpreted cautiously. Conclusions: Actionable signals reside at the domain (micro-competency) level rather than in global leadership composites. Targeted, continuous, unit-embedded development in human- and development-focused competencies—tracked with dual-lens (manager–staff) measurement and linked to retention KPIs—may help nudge turnover cognitions downward. Key limitations include the cross-sectional, perception-based design and two-site setting. Findings nonetheless align with international workforce challenges and may be transferable to similar hospital contexts. Full article

Background/Objectives: Toxic leadership has arisen as a matter of serious concern within the nursing profession, with growing evidence linking it to diminished job satisfaction, ineffective conflict management, and weakened organizational commitment. These effects not only compromise nurse retention but also threaten the quality of patient care and overall healthcare outcomes. This scoping review aimed to examine the impact of toxic nursing leadership on staff retention by synthesizing evidence from existing literature and a broad range of published studies. Methods: A comprehensive literature search was conducted across multiple databases, including PubMed/MEDLINE, Scopus, CINAHL and Science Direct databases yielding 1356 articles. Of these, 18 met the predefined inclusion criteria. The scoping review followed the six-stage methodological framework proposed by Arksey and O’Malley. Thematic analysis identified two core categories: (a) key dimensions shaping perceptions of toxic leadership and (b) the impact of toxic leadership on nursing staff retention. Results: The findings reveal that toxic leadership contributes to organizational silence, emotional exhaustion, diminished psychological safety, and low professional commitment. Such behaviors not only jeopardize nurse engagement and productivity but also negatively affect patient safety and care quality. In contrast, leadership styles such as transformational and transactional leadership are associated with higher job satisfaction, reduced burnout, and improved retention outcomes. Conclusions: This review underscores the need for healthcare organizations to identify and address toxic leadership behaviors promptly. By promoting supportive and ethical leadership styles, institutions can foster a healthier workplace, improve nurse retention, and ultimately enhance the quality of care. The study offers practical implications for healthcare administrators, emphasizing leadership development. Full article

Latvia faces one of the lowest nurse-to-population ratios in the EU, resulting in critical staff shortages in intensive care units (ICUs). Nurses frequently care for more patients than recommended, which not only compromises patient safety but also places heavy psycho-emotional burdens on staff. The aim of this study was to examine organizational-level relationships between objectively measured ICU nursing workload and subjectively reported psycho-emotional outcomes, including moral distress, burnout, and intention to leave one’s job. A secondary analysis combined data from two cross-sectional studies conducted in 2025. Workload was measured using 3420 Nursing Activities Score (NAS) protocols from three hospitals, while 155 ICU nurses from 16 units completed validated instruments assessing moral distress, burnout, and turnover intentions. The findings revealed persistent nurse shortages, with one ICU showing deficits exceeding 70% and mean NASs above 100 points per nurse per shift. Nurses reported moderate moral distress, particularly in situations of unsafe patient ratios and aggressive treatment, while burnout levels were moderate to high, especially in personal and work-related dimensions. About one-quarter of respondents were actively considering leaving their jobs. Moral distress significantly correlated with burnout (r = 0.357, p < 0.001), and organizational-level comparison indicated that higher workload was associated with greater emotional strain. These results not only highlight urgent national challenges but also resonate with international evidence on the link between unsafe staffing, moral distress, and workforce sustainability. Implementing systematic workload monitoring, safe staffing ratios, and structured support mechanisms is essential to safeguard ICU nurses’ well-being, reduce turnover, and protect patient safety in both Latvian and global contexts. Full article

Background/Objectives: Fear of terrorism can impact psychological functioning and behavior even without direct exposure. Little is known about how anticipatory terrorism fears manifest among nursing students in European contexts. This study assessed terrorism catastrophizing among Croatian nursing students and examined sociodemographic predictors. Methods: A cross-sectional correlational study was conducted between October and December 2024 among 348 nursing students, using the validated Terrorism Catastrophizing Scale (TCS). Behavioral and habitual changes related to the terrorism threat were also measured. Non-parametric tests and bootstrapped regression analyses (1000 resamples) explored associations with sociodemographic variables. Results: Mean TCS score was 38.4 ± 8.0, indicating moderate catastrophizing, with subscale means of 16.8 (Helplessness), 11.7 (Rumination), and 9.8 (Magnification). Female students scored higher across all TCS measures (p < 0.001). Employment was associated with greater catastrophizing and behavioral changes, while urban residence was linked to fewer habitual and overall behavioral modifications. Higher income was associated with lower magnification. TCS scores correlated moderately with behavioral changes (rs = 0.27, p < 0.001). Non-parametric tests (Mann–Whitney U, Kruskal–Wallis, Spearman correlation) were applied due to non-normal distributions. Conclusions: Terrorism catastrophizing in this population is moderate and influenced by gender, employment, and residential context. Findings suggest targeted mental health support and tailored risk communication strategies may benefit nursing students in similar low-risk settings. Full article

Introduction/Objectives: Cervical cancer screening is a vital preventive strategy, yet the extent of healthcare workers’ knowledge, attitudes, and practices (KAP) can significantly influence its uptake, especially in rural settings. This study aimed to explore the knowledge, attitudes, and practices regarding cervical cancer screening among nurses in selected rural health facilities of the Eastern Cape province, South Africa. Methods: A cross-sectional, quantitative study was conducted among 108 nurses selected from 12 health facilities across two districts in the Eastern Cape. All participants had received some training on cervical cancer screening. Structured questionnaires were used to assess knowledge, attitudes, and practices. Comparisons between professional nurses (higher academic qualification) and enrolled nurses (lower academic qualification) were made using appropriate statistical tests. Results: Findings revealed significant disparities in knowledge and attitudes between professional and enrolled nurses. Professional nurses demonstrated significantly better knowledge and more positive attitudes towards cervical cancer screening than enrolled nurses, who showed inadequate knowledge (p = 0.021) and negative attitudes (p = 0.023). Despite universal training, the level of academic qualification remained a key factor influencing KAP. Conclusions: Academic qualification is closely linked to knowledge and attitudes regarding cervical cancer screening among nurses. Health workforce policies and programmatic initiatives should prioritize targeted training for enrolled nurses, focusing on addressing specific knowledge and skill gaps. Tailored interventions are recommended to enhance competencies and improve cervical cancer screening practices among all nursing cadres. 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

Hand hygiene (HH) is universally recognized as a pillar of infection prevention and control (IPC), both in hospitals and long-term care facilities such as nursing homes (NHs). An annual national survey based on the voluntary notification of purchased alcohol-based hand rubs (ABHRs) has been set up in France since 2019 to appraise the compliance to HH in NHs. The results pertaining to the Hauts-de-France (HdF) region were analyzed over the 2018–2023 period. The impact of factors such as the year, structure status, availability of an infection control link (ICL) nurse and/or an IPC team as well as constant participation in the survey was evaluated. A clear rise in the consumption of ABHRs was witnessed in 2020 followed by a progressive return to the 2018 baseline by 2023 for most NHs. This decrease was significantly less marked in NHs constantly participating in the survey. The ABHR indicator’s annual values were significantly higher in public NHs than in associative ones and in NHs with available ICL nurses/IPC teams. Finally, even though less than 50% of regional NHs reached the target of four daily ABHR uses per resident, they more frequently met it than French ones as a whole. This result underscores the need for ceaselessly reiterating the importance of HH and for pursuing training efforts in NHs with the help of ICL nurses and IPC teams. 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

Background: Nursing students usually face excessive academic and clinical demands that negatively impact their sleep quality. Physical activity (PA) has been proposed to enhance sleep, yet few investigations have focused on this correlation within the Saudi environment. The purpose of this research was to determine the relationship between PA and sleep quality in Saudi nursing students. Methodology: A cross-sectional study was conducted among a sample of 554 nursing students from different universities in Saudi Arabia. The International Physical Activity Questionnaire–Short Form (IPAQ-SF) and the Pittsburgh Sleep Quality Index (PSQI) were used to collect data. Snowball sampling was used to recruit the participants through social media. Descriptive statistics, Pearson correlation, and inferential tests were employed for the analysis. Results: Most participants were female (85.1%) and aged 18–34 years (95.5%). LPA levels were reported by 59.6% of students, and only 8.2% engaged in VPA. The majority (91%) reported poor sleep duration (<5 h), and 57.4% had poor sleep efficiency. Overall, 86.7% of students experienced poor sleep quality. Gender and GPA were significantly associated with both PA and sleep quality. Female students and those with lower GPAs were more likely to report LPA and poor sleep. Marital status was also associated with higher levels of VPA. No significant associations were found with age, academic year, region, income, or parental education. A statistically significant positive correlation was found between PA and sleep quality (r = 0.192, p < 0.001), suggesting that increased PA is modestly associated with better sleep. Conclusion: The research shows a high rate of poor sleep and low physical activity in nursing students, indicating an alarming health trend. Although PA was linked significantly to better sleep, the modest strength indicates the necessity for multi-component interventions. Structured PA programs and sleep hygiene education should be incorporated into nursing curricula by universities to foster students’ well-being and academic performance. Full article

Breast milk is the ideal source of nutrition for infant growth and development. However, when nursing mothers consume aflatoxin B₁ (AFB₁)-contaminated food, the hydroxylated form aflatoxin M₁ (AFM₁) is transferred to breast milk and urine. AFB₁ and its metabolite AFM₁ are potent carcinogens and can pose significant risks to food safety and public health worldwide. This study determined the prevalence of AFM₁ in the breast milk and urine of nursing mothers in Bangladesh and estimated infant exposure to this toxin. Breast milk and urine samples (72 each), collected from nursing mothers in three different regions of the country, were analyzed for AFM₁ occurrence via a sensitive enzyme-linked immunosorbent assay (ELISA). AFM₁ was present in 88.9% of urine samples, with a mean concentration of 109.9 ± 52.8 pg/mL, ranging from 40.0 to 223.8 pg/mL. AFM₁ was also detected in 50% of the breast milk samples, with a mean concentration of 4.6 ± 0.7 pg/mL, ranging from 4.0 to 6.1 pg/mL. A strong correlation (r = 0.72) was observed between milk and urinary AFM₁ levels, indicating these as suitable biomarkers of AFB₁ exposure. Yet, no significant correlations were identified between AFM₁ levels in either milk or urine and the food items typically consumed by nursing mothers. The average estimated daily intake (EDI) for AFM₁ with breast milk was 0.59 ng/kg bw/day, with no significant difference between infants (0.57 ng/kg bw/day) and toddlers (0.65 ng/kg bw/day). A comparison of computed EDI ranges for AFM₁ with a proposed tolerable daily intake value resulted in Hazard Indices below 1 for all exposure scenarios. This indicates that the AFM₁ concentrations in breast milk from three regions of Bangladesh raise no concern. Also, the measured levels were far lower than the maximal levels set in the EU regulations for AFM₁ in dairy milk and infant formula (50 ng/kg and 25 ng/kg, respectively). Full article

Background: Traumatic brain injury (TBI) is a major cause of death and disability worldwide. Patient disposition following TBI has been shown to interact with factors such as age, sex, and injury severity to impact clinical outcomes. Discharge home is associated with better functional outcomes and lower mortality, while discharge to rehabilitation or long-term care facilities is linked to greater injury severity, older age, and higher comorbidity burden. The aim of this study was to further correlate clinical outcomes with discharge dispositions in patients with severe TBI. Methods: This is a retrospective study (2020–2023) of dispositions in patients with severe TBI with AIS (head) ≥ 3. We investigated the relationship between patient disposition and a range of clinical variables, using both parametric (ANOVA) and non-parametric (Kruskal–Wallis, Wilcoxon, Van der Waerden, Savage, Kolmogorov–Smirnov, and Cramer–von Mises) statistical tests. Variables significant in univariate analysis were entered into a multinomial logistic regression model, with discharge home as the reference group. Results: In a cohort of 824 patients, 25.1% were female (n = 207) and 74.9% were male (n = 617). The mean age was 64.1 years for females and 48.9 years for males. Those admitted for severe TBI were included in our analysis. Most patients were discharged home (52.8%), followed by death (12.4%), inpatient rehab (5.1%), and home with services (5.6%). Significant associations were found between disposition and sex, with both males and females most likely to be discharged home (p = 0.0174), as well as between disposition and injury type (p = 0.0186). Disposition was significantly associated with most major clinical variables: hospital length of stay (HLOS), vent days, Glasgow Coma Scale (GCS), and Injury Severity Score (ISS), with p-values < 0.0001 for ANOVA and non-parametric tests. Longer HLOS and ICULOS were associated with discharge to skilled nursing facilities (SNF) most frequently. Days on mechanical ventilation correlated most strongly with discharge to SNF. Lower GCS scores and higher AIS and ISS scores were linked to death or brain death. Prolonged EDLOS was predominantly associated with psychiatric admissions. Higher levels of ETOH were associated with discharge to police custody, followed by homelessness. Conclusions: Our study supports existing evidence that discharge disposition following severe TBI is influenced by several factors, such as injury severity, age, sex, and clinical variables, such as length of stay and ventilator days. Full article

Background/Objectives: The integration of AI chatbots in nursing education, particularly in simulation-based learning, is advancing rapidly. However, there is a lack of structured evaluation models, especially to assess AI-generated simulations. This article introduces the AI-Integrated Method for Simulation (AIMS) evaluation framework, a dual-phase evaluation framework adapted from the FAITA model, designed to evaluate both prompt design and chatbot performance in the context of nursing education. Methods: This simulation-based study explored the application of an AI chatbot in an emergency planning course. The AIMS framework was developed and applied, consisting of six prompt-level domains (Phase 1) and eight performance criteria (Phase 2). These domains were selected based on current best practices in instructional design, simulation fidelity, and emerging AI evaluation literature. To assess the chatbots educational utility, the study employed a scoring rubric for each phase and incorporated a structured feedback loop to refine both prompt design and chatbox interaction. To demonstrate the framework’s practical application, the researchers configured an AI tool referred to in this study as “Eval-Bot v1”, built using OpenAI’s GPT-4.0, to apply Phase 1 scoring criteria to a real simulation prompt. Insights from this analysis were then used to anticipate Phase 2 performance and identify areas for improvement. Participants (three individuals)—all experienced healthcare educators and advanced practice nurses with expertise in clinical decision-making and simulation-based teaching—reviewed the prompt and Eval-Bot’s score to triangulate findings. Results: Simulated evaluations revealed clear strengths in the prompt alignment with course objectives and its capacity to foster interactive learning. Participants noted that the AI chatbot supported engagement and maintained appropriate pacing, particularly in scenarios involving emergency planning decision-making. However, challenges emerged in areas related to personalization and inclusivity. While the chatbot responded consistently to general queries, it struggled to adapt tone, complexity and content to reflect diverse learner needs or cultural nuances. To support replication and refinement, a sample scoring rubric and simulation prompt template are provided. When evaluated using the Eval-Bot tool, moderate concerns were flagged regarding safety prompts and inclusive language, particularly in how the chatbot navigated sensitive decision points. These gaps were linked to predicted performance issues in Phase 2 domains such as dialog control, equity, and user reassurance. Based on these findings, revised prompt strategies were developed to improve contextual sensitivity, promote inclusivity, and strengthen ethical guidance within chatbot-led simulations. Conclusions: The AIMS evaluation framework provides a practical and replicable approach for evaluating the use of AI chatbots in simulation-based education. By offering structured criteria for both prompt design and chatbot performance, the model supports instructional designers, simulation specialists, and developers in identifying areas of strength and improvement. The findings underscore the importance of intentional design, safety monitoring, and inclusive language when integrating AI into nursing and health education. As AI tools become more embedded in learning environments, this framework offers a thoughtful starting point for ensuring they are applied ethically, effectively, and with learner diversity in mind. Full article