Abstract: Objectives: Intensive care units (ICUs) are characterised by high care complexity and nursing workload, which directly affects patient safety and staff sustainability. Latvia faces a chronic shortage of nurses, particularly in intensive care, yet systematic national data on nursing workload have been lacking. This study aimed to quantitatively assess nursing workload in Latvian ICUs using the Nursing Activities Score (NAS) and to evaluate its relationship with staffing adequacy. Methods: A prospective, multicentre observational study was conducted over six months (May–November 2025) in 14 Lat-vian ICUs representing all three levels of intensive care. Nursing workload was meas-ured using the NAS during each 12-hour shift. A total of 28,079 complete NAS obser-vations were analysed using descriptive statistics, inferential tests (t-tests, ANOVA), mixed-effects modelling, regression analysis, and time-series forecasting. Results: The mean NAS was 65.45 (SD = 25.76), equivalent to an average of 15.71 nursing care hours per patient per day. Workload remained similarly high during day and night shifts. Significant differences were observed between ICUs and care levels, with level 2 units showing the highest workload. The average nursing shortage rate was 42.6% and was strongly predicted by NAS values (R² = 0.115), whereas shift type and unit level had minimal explanatory power. Conclusions: ICU nursing workload in Latvia is persis-tently high and unevenly distributed across units. Staffing levels are not adequately adjusted to actual care demands. Integrating NAS-based workload monitoring into staffing models is essential for evidence-based workforce planning, improving patient safety, and reducing nurse overburdening.

Abstract: Introduction: Nursing educators and clinical leaders face persistent challenges in engaging the next generation of nurses, often characterized by short attention spans, frequent phone use, and underdeveloped communication skills. This article describes the design and delivery of a full-day interactive teaching workshop for nursing faculty, senior clinical nurses, and nurse leaders, developed using a design-thinking approach supported by generative AI. Methods: The workshop comprised three thematic sessions: (1) Learning styles across generations, (2) Interactive teaching methods, and (3) Application of interactive teaching strategies. Generative AI was used during planning to create icebreakers, discussion prompts, clinical teaching scenarios, and application templates. Design decisions emphasized low-tech, low-prep strategies suitable for spontaneous clinical teaching, thereby reducing barriers to adoption. Activities included emoji-card introductions, quick generational polls, color-paper reflections, portable whiteboard brainstorming, role plays, fishbowl discussions, gallery walks, and movement-based group exercises. Results: Analysis of 59 participant reflections revealed six interconnected themes, grouped into three categories: engagement and experiential learning, practical applicability and generational awareness, and facilitation, environment, and motivation. Participants emphasized the workshop’s lively pace and hands-on design, noting “It was impossible to fall asleep; we were always talking, sharing, writing, or moving.” Experiencing strategies firsthand built confidence for application, while generational awareness encouraged reflection on adapting methods for younger learners. The facilitator’s passion, personable approach, and structured use of peer learning created a psychologically safe and motivating climate, leaving participants recharged and inspired to integrate interactive methods. Discussion: The workshop illustrates how AI-assisted, design-thinking-driven professional development can model effective strategies for next-generation learners. When paired with skilled facilitation, AI-supported planning enhances engagement, fosters reflective practice, and promotes immediate transfer of interactive strategies into diverse teaching settings.

Abstract: Background: In healthcare, Electronic Medical Records (EMRs) offer centralized access to patient data and enable evidence-based clinical decision-making. and operational efficiency. However, they have introduced administrative burdens for the clinicians, potentially impacting job satisfaction and care quality. Despite the widespread EMR adoption in Saudi Arabia, the issue of time burden related to EMRs and the factors re-lated to it are underexplored. Objectives: To measure the average number of hours (per month and as percentage out of total monthly working hours) of EMR use among physicians and nurses, compare the mean monthly hours of EMR use between them, and identify the demographic predictors of extended hours of EMR use. Moreover, it aims to understand the perceived challenges and barriers of timely filling EMRs, and the impact of EMRs on quality of patient care. Methods: A sequential mixed-methods study was conducted at three Security Forces Hospitals in Riyadh, Dammam, and Makkah. Quantitively, a correlational cross-sectional design was used was employed with multistage stratified sampling using a validated 30-item questionnaire, and data were analyzed using differential and inferential statistics. The qualitative phase in-volved purposive sampling of ten clinicians and semi-structured interviews analyzed through thematic analysis. Results: A total of 503 professionals (162 physicians, 341 nurses) participated. Majority were females (67.2%), aged 30 to 40 years (44.9%), and non-Saudi (62%). Nurses reported significantly higher mean of EMR usage hours/day than physicians (5.43 versus 4.34 hours/day, p=0.001). Significant predictors of ex-tended EMR use include age 30-50 years, female gender, non-Saudi nationality, higher education, nursing profession, longer healthcare experience, 5-10 years EMR experi-ence, 10+ hours EMR training, and participants from Makkah. Qualitative analysis identified barriers such as infrastructure constraints, system performance and tech-nical issues, lack of IT support, and workflow and professional burden. Regarding EMR impact, they improved professional practice and patient safety, however, concerns were raised regarding adjustments in work routine Conclusion: EMR use carries con-siderable administrative burden, especially nurses when compared to physicians. Ad-dressing the identified barriers through targeted training, better system design, and improved workflows could boost efficiency and support high-quality patient care. The findings offer evidence-based insights to guide policy and system-level improvements.

Abstract: Background: Treatment nonadherence in oncology is prevalent and often assessed by surveys that miss the qualitative reasons underpinning nonadherence or treatment discordance. We aimed to synthesize evidence from Natural Language Processing (NLP) studies, primarily sentiment analysis of patient generated content (social media, forums, blogs, review platforms, and survey free text), to identify communication-related and relational factors linked to nonadherence/concordance. Methods: We conducted a scoping review following PRISMA-ScR. Searches of PubMed, CINAHL, and Scopus (2013 early 2024) targeted NLP studies of the cancer patient experience; conventional reports were included where they clarified communication/adherence constructs. Data were charted against source, cancer type, NLP technique, and inferred adherence/concordance factors, then synthesized using discourse analysis and narrative synthesis. Results: Four patient side themes consistently emerged: (1) unmet emotional needs; (2) suboptimal information and communication; (3) unclear treatment concordance within patient/person-centred care; and (4) online misinformation dynamics (and perceptions of clinician bias). Sentiment analysis detected fine grained emotions (fear, disgust, sadness, surprise), informational gaps and trust issues that are often less visible in structured surveys. Conclusions: Patient voice data offer actionable insights for nursing practice: routine distress screening, teach back strategies, misinformation countermeasures, and explicit concordance checks. Integrating these into person-centred workflows may improve adherence and shared decision making. Registration: Not registered.

Abstract: Background/Objectives: Delirium is frequent and serious in older adults attending the emergency department (ED), but evidence on its pharmacological management in this setting is limited. This study aimed to quantify the pharmacological treatment of de-lirium in older adults in the ED and examine its association with subsequent hospital admission. Methods: An observational cross-sectional study was conducted between November 2021 and June 2022 in a Spanish ED. The sample included 153 adults aged 65 years or older with clinician-diagnosed delirium. Clinical, triage, and medication data were obtained from electronic medical records, and associations with hospital admis-sion were analysed using multivariable logistic regression. Results: Ninety-one partic-ipants (59.5%) were hospitalised. Antipsychotic, analgesic, and benzodiazepine use was associated with increased risk of hospitalisation. Absence of an underlying cause was a protective factor. The logistic regression model was significant. Conclusions: Specific drug families were associated with a higher likelihood of hospital admission in older adults with delirium in the ED. These findings support safer and more individualised pharmacological approaches and highlight the need for studies evaluating targeted interventions.

Abstract: Background There is a high correlation between a trauma history and development of mental health conditions. By providing safe and containing (trauma-informed) working relationships, mental health nurses can validate mental distress, reduce re-traumatisation and support recovery. Trauma informed education (TIE) has become commonplace in nurse education however, little is known about students’ experience of this and its impact on their practice. Purpose This study aimed to evaluate and explore student mental health nurses’ perspectives on TIE and its impact on their practice to contribute to the knowledge and evidence base that informs nurse and broader healthcare education. Methods This qualitative, phenomenological study used focus group interviews (n=3) with 11 mental health nursing students, reported using SRQR Checklist. Analysis Data generated was analysed using Braun and Clarke’s (2013) Reflective Thematic Analysis. Findings Three themes were identified: 1. A compass for practice; 2. Mental Health Nursing: Between paradigms; 3. Supporting personal development and wellbeing. Integrating TIE within nurse education can support students to adopt the principles of trauma-informed care (TIC) personally and in their practice. Improved self-awareness, recognition of trauma and adopting self-care strategies were valuable in supporting personal resilience and wellbeing, valuable in managing the challenges of mental health practice. Recommendations TIE has the potential to have a positive impact on wellbeing therefore integration should be considered for all healthcare programmes. Further interprofessional research is needed to establish the longer-term impact of TIE as students’ progress into their professional career. Limitations This is an initial small-scale study with self-selecting students which limits generalisability. Exploring sustained impact through longitudinal study may be valuable.

Abstract: Background: University students are often exposed to environments that encourage unhealthy eating, but universities can promote better health and sustainability by making sustainable food options more accessible. Methods: Temporal changes in dietary patterns and environmental footprints of 1684 students at the University of Rijeka, Croatia, over a 16-year period (2009-2025) were retrospectively analyzed using data from three cross-sectional studies. Results: A significant transition toward less sustainable diets, increased consumption of animal-based foods, and proinflammatory eating habits was observed (both p< 0.001). Adherence to the Mediterranean and Planetary Health Diet declined over time (p< 0.001), followed by increased prevalence of overweight and obesity. Consumption of most food groups increased, leading to higher water and ecological footprints. Only the intake of fruits, vegetables, whole grains, and fish declined, which corresponded with reduced carbon footprints for these and a few other food groups, while the environmental impact of other foods significantly increased (all p < 0.001). Gender, diet quality, and a proinflammatory diet were significant predictors of dietary environmental footprints. Conclusion: The findings underscore the need for systemic changes and addressing barriers at the university level to support sustainable eating behaviors. The study offers valuable insights for policymakers, educators, and researchers who aim to help students become health-conscious and environmentally responsible consumers. Further research is needed to explore the broader factors influencing dietary choices and the long-term impact of future institutional interventions.

Abstract:

Introduction: Community preparedness for earthquakes is a crucial aspect of disaster risk reduction (DRR). Spiritual factors are considered a component that influences how communities perceive risks, respond to threats, and recover after a disaster. Research Method: This study aims to analyze the role of community spiritual aspects in earthquake preparedness through a review of international and national literature published in 2010–2024. Result: The results of the study show that spirituality plays a role in shaping risk perception, increasing psychological coping abilities, strengthening social capital, expanding the function of religious institutions, and supporting the post-disaster recovery process. Conclusion: Integrating a spiritual approach into community-based DRR programs can be an effective strategy in strengthening the social and psychological resilience of communities living in earthquake-prone areas.

Abstract: Background/Objectives: Multiple sclerosis (MS) is a chronic neurological disease characterized by demyelination, inflammation, and autoimmunity, leading to progressive physical and psychological impairments. Anxiety and depression are among the most prevalent neuropsychiatric comorbidities in MS, significantly impacting patients’ quality of life (QoL). This study aimed to assess the evolution of anxiety and depression in individuals with relapsing-remitting multiple sclerosis (RRMS) over a six-month follow-up period, identify associated factors, and explore predictive variables. Methods: A prospective observational study was conducted with 35 RRMS patients diagnosed at the Lucus Augusti University Hospital between January 2023 and March 2025. Psychological symptoms were assessed at baseline, 3 months, and 6 months using Goldberg Anxiety and Depression Scale (GADS), the Beck Depression Inventory (BDI), and the Beck Anxiety Inventory (BAI). Data were analyzed using non-parametric and parametric tests to account for the small sample size and distribution of variables. Results: Anxiety and depression were prevalent and persistent in the study population, with no significant changes in mean scores over time (p &gt; 0.05). However, specific symptoms, such as pessimism and loss of pleasure, showed worsening trends, while sadness and guilt remained stable. Sociodemographic factors, including lower income and employment status, were significantly associated with higher anxiety and depression scores (p &lt; 0.05). Additionally, clinical factors such as autoimmune comorbidities and a history of mononucleosis were linked to higher depressive symptoms. Baseline anxiety and depression scores emerged as strong predictors of future levels (p &lt; 0.01), emphasizing the importance of early assessments. Conclusions: Anxiety and depression are prevalent and persistent in RRMS patients, with specific symptoms fluctuating over time. Sociodemographic and clinical factors play a significant role in psychological outcomes, highlighting the need for integrated care models that address both physical and psychosocial aspects of MS. Early psychological assessments and targeted interventions are critical to improving QoL and mitigating the long-term burden of mental health challenges in RRMS.

Abstract:

Background: Ostomy care consultations are essential for promoting patient autonomy and quality-of-life. The integration of innovative technologies may enhance health education and support effective self-care among ostomized patients. Objective: To analyze the impact of health education supported by smart-glasses on the quality of life of ostomized patients. Methods: This is a Pre—post study. A single 60-minute intervention was conducted with 14 ostomized patients (mean age: 57.6±12.6 years; 50% male). The session comprised three phases: (1) assessment of patient knowledge on ostomy management; (2) personalized feedback addressing individual needs; and (3) a hands-on workshop using Vuzix smart-glasses to provide a first-person perspective of ostomy care techniques. Four instructional videos were recorded and made available via a digital platform. Results: At baseline, patients reported moderate limitations in physical function and physical role. General health and vitality indicated fair-to-good perception, while mental health was adequate in 57.1% of participants. Following the intervention, SF-36 score improved significantly, with 53.8% reporting a very good quality of life. Physical function increased with 84.6% rating it as good or excellent. Emotional role improved markedly, and mental health reached 76.9% reporting optimal scores. A strong correlation was observed between baseline and post-intervention SF-36 scores. Conclusion: The integration of smart glasses into health education within nursing-led ostomy consultations significantly improved the quality of life of ostomized patients following digestive surgery.

Abstract:

Objectives: To analyze the anthropometric and laboratory levels associated in adults with diabetes on insulin therapy, monitored by Brazilian Primary Health Care. Methods: Cross-sectional study conducted from August 2024 to January 2025 in 17 Basic Health Units. The final sample included 60 adults (≥18 years) with confirmed type 1 or type 2 diabetes, responsible for insulin preparation and self-administration for at least 6 months. Sociodemographic, clinical, anthropometric, and laboratory data (HbA1c, fasting blood glucose, and blood pressure) were collected by trained undergraduate researchers. Normality was tested using the Shapiro-Wilk test, and variables were described using means, SD, 95% CI, and absolute/relative frequencies. One-sample t-tests compared observed means to international clinical targets (p < 0.05). Results: Most of participants had type 2 diabetes (71.7%), diagnosed >10 years ago (54.9%), and 50% did not perform daily self-monitoring of blood glucose. Insulin therapy was long-established with 90% with >1 year of continuous use. Clinical means were significantly higher than recommended targets for HbA1c (mean = 9.08%; 86.7% altered; p < 0.001) and fasting blood glucose (mean = 198.7 mg/dL; 81.7% altered; p < 0.001). Overweight/excess adiposity were frequent (BMI mean = 26.5 ± 4.85; 58.3% altered), and 63.3% had increased waist circumference. Calf and neck circumferences suggested emerging body-composition risk in part of the sample. Conclusions: Adults on established insulin therapy showed persistent glycemic imbalance and a high frequency of clinically anthropometric risk markers. The findings reinforce the need for individualized metabolic monitoring structured PHC interventions to support safe insulin self-administration.

Abstract: Background: Maternal mortality remains a major global health challenge, disproportionately affecting black and Indigenous women. Hypertensive disorders of pregnancy and postpartum hemorrhage are leading direct causes of maternal death. Artificial intelligence (AI) tools have emerged as potential strategies for predicting these complications, yet concerns persist about their equity and validation across racial groups. Methods: A rapid review was conducted in five databases PubMed, EMBASE, Web of Science, Scopus and LILACS to synthesize recent evidence on the use of AI for preventing maternal mortality due to hypertension and postpartum hemorrhage. Studies published in the last five years that included racial or ethnic data were selected and analyzed narratively. Results: Ten studies met the inclusion criteria, showing high predictive accuracy of AI models (AUROC often >0.95) for severe maternal outcomes. However, few models incorporated racial variables or underwent external validation in racially diverse or low-resource populations. Evidence suggests that unrepresentative datasets may perpetuate or exacerbate existing health inequities. Conclusions: AI demonstrates strong technical performance in predicting maternal complications but limited equity in application. Broader racial representation, external validation, and ethical governance are essential for ensuring that AI-based tools reduce rather than reinforce racial disparities in maternal mortality.

Abstract: Soto Zen Buddhist precepts, contemplative medicine, and nursing are used to examine ethical and spiritual ramifications of being silent in the face of environmental destruction and nuclear hazards. It explores how spiritual integrity can guide personal, professional, and planetary development using a personal narrative based on Soto Zen practice and training in contemplative medicine, as well as a scoping review on spirituality in the Anthropocene. The ongoing threat of nuclear disaster can lead to an instantaneous and irreversible detachment from life, even as climate change takes center stage in international debate. By integrating contemplative frameworks with nursing and interfaith perspectives, the paper positions spirituality as a critical dimension of sustainability and calls for a cultural and spiritual shift toward connection, humility, and reverence as a foundation for planetary health.

Abstract: Objectives: Role clarity is a persistent challenge among Patient Care Technicians (PCTs), contributing to inconsistent task performance and safety risks. In Saudi Arabia, little is known about PCTs’ understanding of their responsibilities. This study assessed baseline knowledge and evaluated the impact of a targeted educational program aimed at improving clarity in roles, safety practices, and communication. Methods: A quasi-experimental pre–post design was used in September 2025 with 35 participants from the Hail Health Cluster. The one-day intervention included lectures, discussions, role-play, and case scenarios. A validated survey assessed four domains: role clarity, core clinical tasks and safety, communication and ethics, and objective knowledge. Paired t-tests were performed using SPSS v29, with effect sizes reported via Cohen’s d. Results: Baseline scores were lowest in objective knowledge (41.4%) and role clarity (62.8%). Post-training, total composite scores improved significantly (+10.88%, p < .001), with the greatest gain in objective knowledge (+19.8%, p < .001). Role clarity showed only a modest, non-significant increase (+3.98%, p = .088). No demographic differences were found. Conclusion: Training enhanced PCT knowledge, but improving role clarity may require longer-term, system-level strategies.

Abstract: Background: The COVID-19 pandemic exacerbated pre-existing inequities in maternity care, particularly among culturally diverse and migrant women. Although data were col-lected during the early pandemic phase, revisiting these experiences offers valuable in-sights for strengthening equity, cultural safety, and system preparedness in maternal healthcare. Methods: A qualitative phenomenological–hermeneutic study was conducted in a tertiary maternity hospital in Spain. Semi-structured interviews were carried out with six women from diverse cultural backgrounds. Data were analysed inductively through thematic analysis, followed by a secondary interpretive review in 2024 to identify endur-ing implications for culturally safe, equitable, and crisis-resilient maternity care. Results: Four main themes emerged: (1) heightened fear and uncertainty surrounding hospital care; (2) emotional distress linked to restrictions on companionship and support; (3) dis-ruption of culturally embedded postpartum practices, resulting in isolation; and (4) health literacy barriers and dependence on informal information sources. Despite these chal-lenges, participants demonstrated notable adaptability and resilience. Conclusions: COVID-19 amplified structural inequities in maternity care for culturally diverse mothers. The findings highlight the need to reinforce cultural safety, health literacy support, lan-guage mediation, family-centred care, and emotional wellbeing. These lessons offer ac-tionable guidance for strengthening resilient, equitable maternal health systems and im-proving preparedness for future public health emergencies.

Abstract:

Background: Digital transformation in healthcare has progressed rapidly in hospitals and primary care, while long-term care facilities have often been left behind. The CareConnect project, funded under the German Model Program for Telecare (§ 125a SGB XI), aimed to implement and evaluate a comprehensive telecare system in two nursing homes in Germany, to improve collaboration across sectors, enhance communication between professionals, and strengthen nurses’ digital competencies. Objective: This implementation study examined the feasibility, acceptability, and early adoption of a multiprofessional telecare system in nursing homes, identifying key facilitators, barriers, and perceived effects on interprofessional collaboration and care delivery. Methods: A participatory implementation design was employed over 15 months (June 2024–August 2025), involving a university hospital, two nursing homes (NHs), and four medical practices in an urban region. The intervention consisted of teleconsultations and interdisciplinary case discussions utilizing a certified video platform, combined with diagnostic devices (e.g., otoscopes, dermatoscopes, ECGs). Implementation data included quantitative usage statistics, researcher observations, and user feedback collected during the rollout phase. Data were analyzed descriptively to assess usage patterns, case characteristics, and implementation experiences. Results: A total of 152 documented telecare contacts were conducted with 69 participating residents. Most interactions occurred with general practitioners (48.7%) and dermatologists (23%). Across all contacts, in 79% of cases, there was no need for an in-person visit or transportation. Physicians rated most cases as suitable for digital management, as indicated by a mean of 4.09 (SD = 1.00) on a 5-point Likert scale. Nurses reported improved communication, time savings, and enhanced technical and diagnostic skills. Key challenges included delayed technical integration, interoperability issues, and varying interpretations of data protection requirements across facilities. Conclusions: The CareConnect pilot demonstrates that telecare can effectively improve access to specialized care and strengthen interprofessional collaboration in nursing homes. A participatory, user-centered approach proved crucial for acceptance and sustainability. Future scale-up requires stable technical infrastructures, clear reimbursement pathways, and harmonized legal frameworks.

Abstract: Background: Compassion is a cornerstone of woman-centred maternity care and a critical determinant of women’s experiences of childbirth. When dignity, empathy, and effective communication are upheld, women perceive childbirth as safe, empowering, and affirming. However, evidence from many settings highlights the persistence of disrespect, neglect, and abuse during facility-based intrapartum care, undermining trust in health services and contributing to poor maternal outcomes. Objectives: This scoping review explored and synthesized evidence on women’s experiences and per-ceptions of care, with a focus on how compassionis are experienced and enacted in healthcare settings. Methods: A systematic search was conducted across EBSCOhost databases, ScienceDirect, CINAHL, PubMed, Web of Science, Medline, and PsycINFO. Fifteen studies met the inclusion criteria. Data was charted and thematically analyzed to identify the role of compassion and related interpersonal factors in shaping wom-en’s intrapartum experiences. Results: The review of fifteen studies identified two main themes and 12 sub-themes related to childbirth experiences. Compassionate care, characterized by respect, empathy, effective communication, and support for autono-my, led to positive childbirth outcomes and encouraged future use of health services. Conversely, care encounters lacking relational elements, including neglect, mistreat-ment, discrimination, and unconsented care, resulted in feelings of humiliation and disempowerment, discouraging women from seeking facility-based care in future. Conclusion: Compassion during intrapartum care is both a fundamental human right and an essential component of quality maternal health services. Addressing persistent mistreatment requires systemic reform, provider training in compassionate, rights-based care, stronger accountability, and the active inclusion of women’s voices in shaping maternity services.

Abstract: Background: Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system that causes progressive disability and psychosocial burden. Understanding how MS affects patients’ quality of life (QoL) is essential for developing patient-centered rehabilitation and psychosocial support interventions. Methods: A cross-sectional study was conducted among adults diagnosed with MS residing in Western Greece. Data were collected using the Multiple Sclerosis Quality of Life-54 (MSQOL-54) questionnaire. Demographic and clinical variables (age, gender, disease duration, and functional status) were analyzed using descriptive and inferential statistics. Pearson correlation and multiple regression analyses were performed to identify factors associated with QoL domains. Additionally, a systematic literature review following PRISMA guidelines was integrated to contextualize findings within the broader evidence base on MS-related QoL. Results: The study included 128 participants (72% female, mean age 39.8 ± 9.4 years). Overall QoL scores indicated moderate impairment (mean composite physical score = 53.6; mental health = 57.4). Fatigue, pain, and depressive symptoms were strongly correlated with lower QoL (p < 0.001). Longer disease duration and higher disability (EDSS ≥ 4) predicted poorer physical functioning. Conversely, higher perceived social and family support predicted better psychological adaptation and higher mental health scores (β = 0.42, p < 0.01). The PRISMA review synthesized 45 studies, confirming disability, fatigue, and depression as universal risk factors, while social support and resilience-building interventions emerged as protective elements. Conclusion: MS substantially impacts both physical and psychosocial dimensions of life. The findings emphasize the importance of integrated care models that combine medical treatment with psychosocial and rehabilitation programs focusing on resilience, coping, and social support. Early interventions may mitigate QoL deterioration and promote holistic well-being. Regional disparities in Western Greece highlight the need for tailored, accessible services.

Abstract: Background/Objectives: Assisted suicide and suicide prevention remain subjects of intense societal, political, and professional-ethical debate in Germany. Nurses working in residential and home-based long-term care (LTC) play a pivotal role in responding to requests for assisted suicide and in supporting suicide prevention. While international research has explored diverse ethical perspectives and challenges related to these issues, little is known about how LTC nurses in Germany experience and navigate them. This study examines German LTC nurses’ ethical perspectives on assisted suicide and suicide prevention and explores the associated ethical challenges. Methods: A qualitative design employing both in-person and online focus groups was used. Data were analyzed following Mayring’s qualitative content analysis. Results: Twelve focus groups with a total of 96 nurses working in residential and home-based LTC were conducted between February and September 2025. Findings show that nurses perceive assisted suicide and suicide prevention as ethically complex and emotionally demanding. Three overarching themes emerged: (1) Intuitive and Emotional Reactions, (2) Ethical Perception and Ethical Reflection, and (3) Ethical Challenges. Conclusions: LTC nurses expressed varying ethical perspectives on and attitudes towards assisted suicide and suicide prevention. The ethical challenges identified may contribute to the development of moral distress. To help nurses navigate these ethically demanding situations, strategies at multiple levels are required. These include continuous ethics education, an open ethical culture, role definitions and clear professional guidance, alongside societal support for equitable access to general healthcare and suicide prevention services.

Abstract: Aim: To examine the professional role development of new graduate nurses (NGNs) across three transition stages within a major Australian health service. Background: The shift from student to registered nurse is a critical period marked by emotional strain, role ambiguity, and transition shock. Structured support programs have emerged to ease this transition, yet few are evaluated through longitudinal, theory-informed approaches using validated tools. Design: A longitudinal quantitative study guided by Duchscher’s Stages of Transition Theory and the Transition Shock Model. Methods: A customised 75-item questionnaire, adapted from the Professional Role Transition Risk Assessment Instrument and Professional and Graduate Capability Framework, was distributed across three transition points (March 2020 to March 2021). The survey assessed four domains: Responsibilities, Role Orientation, Relationships, and Knowledge and Confidence. Descriptive statistics, Principal Component Analysis, Chi-square tests, and multinomial logistic regression were used to analyse patterns, trends, and predictors of successful transition. Results: A clear developmental trajectory emerged. Early-stage participants experienced stress, low self-efficacy, and role confusion. By Stage 3, most demonstrated increased clinical confidence, autonomy, and integration into professional healthcare teams. A coordinator-to-graduate ratio of 1:12 facilitated personalised mentorship and supportive practice environments. Statistically significant improvements were observed in critical thinking, leadership perception, emotional resilience, and team communication. Conclusions: This study provides robust empirical support for theoretically grounded and policy-aligned Graduate Nurse Transition Programs. Targeted interventions tailored to each transition phase—such as early mentorship, mid-stage stress support, and end-stage leadership development—can enhance confidence, improve role clarity, and promote long-term workforce capability and sustainability.