Sort by
Review
Public Health and Healthcare
Nursing
System Efficiency and Workforce Well-being of Self-Managed Nursing Teams: A Systematic Review
FA Etindele Sosso
Abstract: Background: The global healthcare landscape is currently facing a dual crisis of economic sustainability and organizational burnout, largely stemming from rigid, fragmented delivery models. Objectives: To evaluate the global organizational and economic outcomes of self-managed nursing teams (SMNTs) using the Relational and Organizational Efficiency Model (ROEM), focusing on system efficiency and workforce well-being. Design: A comparative systematic review following PRISMA guidelines. Data Sources: A systematic search was conducted across PubMed, Scopus, Web of Science and CINAHL for peer-reviewed articles published between 1990 and 2025. Review Methods: The methodological quality of the 32 included studies was appraised using the Mixed Methods Appraisal Tool (MMAT). Data were synthesized across the macro, meso and micro levels of the ROEM framework. Results: SMNT models foster relational efficiency, yielding high patient satisfaction, stronger continuity of care, and up to a 40% reduction in care hours in fully integrated models. However, the ROEM analysis reveals an "autonomy-strain paradox" at the micro-level: without adequate macro-level funding shifts (e.g., transitioning away from Fee-For-Service) and structural support, increased operational autonomy leads to high psychological distress and cognitive overload among nurses. Conclusions: Transitioning to SMNTs is a viable strategy to mitigate professional burnout and improve system efficiency. Successful scaling requires dismantling traditional hierarchies, shifting managers to coaching roles, and implementing value-based health policies.
Abstract: Background: The global healthcare landscape is currently facing a dual crisis of economic sustainability and organizational burnout, largely stemming from rigid, fragmented delivery models. Objectives: To evaluate the global organizational and economic outcomes of self-managed nursing teams (SMNTs) using the Relational and Organizational Efficiency Model (ROEM), focusing on system efficiency and workforce well-being. Design: A comparative systematic review following PRISMA guidelines. Data Sources: A systematic search was conducted across PubMed, Scopus, Web of Science and CINAHL for peer-reviewed articles published between 1990 and 2025. Review Methods: The methodological quality of the 32 included studies was appraised using the Mixed Methods Appraisal Tool (MMAT). Data were synthesized across the macro, meso and micro levels of the ROEM framework. Results: SMNT models foster relational efficiency, yielding high patient satisfaction, stronger continuity of care, and up to a 40% reduction in care hours in fully integrated models. However, the ROEM analysis reveals an "autonomy-strain paradox" at the micro-level: without adequate macro-level funding shifts (e.g., transitioning away from Fee-For-Service) and structural support, increased operational autonomy leads to high psychological distress and cognitive overload among nurses. Conclusions: Transitioning to SMNTs is a viable strategy to mitigate professional burnout and improve system efficiency. Successful scaling requires dismantling traditional hierarchies, shifting managers to coaching roles, and implementing value-based health policies.
Posted: 08 July 2026
Article
Public Health and Healthcare
Nursing
Knowledge, Beliefs, Attitudes, and Intention to Support Medical Cannabis Among Vietnamese Nursing Students: A Convergent Parallel Mixed-Methods Study
Bao Thy Vuong
,Uyen Thi To Nguyen
,Thanh Thao Trang Le
,Nguyen Cong Cuu
,Cua Ngoc Le
Abstract: (1) Background: Medical cannabis (MC) is attracting attention globally due to its therapeutic potential; however, the preparedness of nursing students in countries where MC remains banned is limited. The convergent parallel mixed-methods study examined the knowledge, attitudes, beliefs, and intention. (2) Methods: A cross-sectional survey was conducted with 422 nursing students selected through simple random sampling at Dong Thap Medical College, Vietnam, and in-depth interviews were conducted with 10 purposefully selected participants. Descriptive statistics, ordinal logistic regression, and thematic analysis were used in the data analysis. (3) Results: Nursing students demonstrated average knowledge and positive attitudes and beliefs toward MC. Over 50% of students were undecided about supporting MC legalization. Deep knowledge and stronger beliefs about therapeutic benefits and safety were independently associated with higher intention to advocate for MC, while attitudes were not statistically significant. Four themes emerging include therapeutic value, safety and ethical concerns, professional readiness, and social, legal, and organizational impacts, providing contextual explanations for the quantitative results. (4) Conclusion: The adoption of MC is dependent not only on knowledge and beliefs but also on confidence in evidence-based practice, professional readiness, and regulatory oversight. Nursing education on MC can enhance future workforce readiness and support evidence-based healthcare policy.
Abstract: (1) Background: Medical cannabis (MC) is attracting attention globally due to its therapeutic potential; however, the preparedness of nursing students in countries where MC remains banned is limited. The convergent parallel mixed-methods study examined the knowledge, attitudes, beliefs, and intention. (2) Methods: A cross-sectional survey was conducted with 422 nursing students selected through simple random sampling at Dong Thap Medical College, Vietnam, and in-depth interviews were conducted with 10 purposefully selected participants. Descriptive statistics, ordinal logistic regression, and thematic analysis were used in the data analysis. (3) Results: Nursing students demonstrated average knowledge and positive attitudes and beliefs toward MC. Over 50% of students were undecided about supporting MC legalization. Deep knowledge and stronger beliefs about therapeutic benefits and safety were independently associated with higher intention to advocate for MC, while attitudes were not statistically significant. Four themes emerging include therapeutic value, safety and ethical concerns, professional readiness, and social, legal, and organizational impacts, providing contextual explanations for the quantitative results. (4) Conclusion: The adoption of MC is dependent not only on knowledge and beliefs but also on confidence in evidence-based practice, professional readiness, and regulatory oversight. Nursing education on MC can enhance future workforce readiness and support evidence-based healthcare policy.
Posted: 06 July 2026
Review
Public Health and Healthcare
Nursing
Pathophysiological Mechanisms of the Microbiota-Gut-Brain Axis in Amyotrophic Lateral Sclerosis: Intestinal Permeability, Neuroinflammation, and Therapeutic Horizons for Non-Motor Symptoms
Elena Sanchis-Sanchis
,José Enrique de la Rubia Ortí
,David Sancho-Cantus
,Cristina Cunha-Pérez
,Jorge Casaña-Mohedo
Abstract: Amyotrophic Lateral Sclerosis (ALS) is a progressive neurodegenerative disorder where systemic pathophysiological alterations significantly contribute to disease progression and non-motor manifestations, such as depression and anxiety. The microbiota-gut-brain axis represents a critical bidirectional pathway where intestinal dysbiosis and epithelial barrier disruption catalyze central neuroinflammation. This scoping review synthesizes evidence from 43 empirical and analytical studies across 28 countries, mapping the findings under the WHO International Classification of Functioning (ICF) framework. Pathophysiological data reveal a profound taxonomic shift in ALS patients, characterized by a severe depletion of neuroprotective, butyrate-producing genera (Akkermansia and Prevotella) and an enrichment of pro-inflammatory Enterobacteriaceae. This dysbiotic state leads to structural damage of the intestinal mucosa, alteration of Paneth cells, and down-regulation of tight junction proteins (zonulin), triggering a "leaky gut" phenomenon. The subsequent systemic translocation of lipopolysaccharides (LPS) induces TLR4-mediated endotoxemia, microglial hyperactivation, and accelerated motor neuron apoptosis. Conversely, therapeutic modulation via Fecal Microbiota Transplantation (FMT), psychobiotics, and metabolic interventions (ketogenic or Mediterranean diets) demonstrates significant efficacy in restoring epithelial integrity, mitigating mitochondrial hypermetabolism, and reducing emotional distress scales. This review identifies a critical research gap in the microstructural characterization of the enteric nervous system in ALS. Integrating microbiome-targeted biomarkers into clinical protocols is essential for a stratified, multi-systemic therapeutic approach to improve patient prognosis and psychological well-being.
Abstract: Amyotrophic Lateral Sclerosis (ALS) is a progressive neurodegenerative disorder where systemic pathophysiological alterations significantly contribute to disease progression and non-motor manifestations, such as depression and anxiety. The microbiota-gut-brain axis represents a critical bidirectional pathway where intestinal dysbiosis and epithelial barrier disruption catalyze central neuroinflammation. This scoping review synthesizes evidence from 43 empirical and analytical studies across 28 countries, mapping the findings under the WHO International Classification of Functioning (ICF) framework. Pathophysiological data reveal a profound taxonomic shift in ALS patients, characterized by a severe depletion of neuroprotective, butyrate-producing genera (Akkermansia and Prevotella) and an enrichment of pro-inflammatory Enterobacteriaceae. This dysbiotic state leads to structural damage of the intestinal mucosa, alteration of Paneth cells, and down-regulation of tight junction proteins (zonulin), triggering a "leaky gut" phenomenon. The subsequent systemic translocation of lipopolysaccharides (LPS) induces TLR4-mediated endotoxemia, microglial hyperactivation, and accelerated motor neuron apoptosis. Conversely, therapeutic modulation via Fecal Microbiota Transplantation (FMT), psychobiotics, and metabolic interventions (ketogenic or Mediterranean diets) demonstrates significant efficacy in restoring epithelial integrity, mitigating mitochondrial hypermetabolism, and reducing emotional distress scales. This review identifies a critical research gap in the microstructural characterization of the enteric nervous system in ALS. Integrating microbiome-targeted biomarkers into clinical protocols is essential for a stratified, multi-systemic therapeutic approach to improve patient prognosis and psychological well-being.
Posted: 30 June 2026
Article
Public Health and Healthcare
Nursing
School Bullying, Self-Esteem, and Emotional Intelligence Among Primary Education Students: A Gender-Based Pretest Analysis from a School Nursing Perspective
Malena Barba Muñoz
,María Pilar Molés-Julio
,José Antonio Zafra-Agea
Abstract: Background: School bullying represents a major public health challenge that negatively affects children's emotional well-being and psychosocial development. Self-esteem and emotional intelligence have been identified as potential protective factors, although evidence from a school nursing perspective in Primary Education remains limited. This study aimed to analyze the relationships between school bullying, self-esteem, and perceived emotional intelligence among Primary Education students, considering gender differences before the implementation of a nurse-led psychoeducational intervention. Methods: A multicenter cross-sectional pretest study was conducted among 507 students from five educational centers in Madrid, Spain. School bullying was assessed using the Peer Harassment Questionnaire (PHQ), self-esteem with the Self-Esteem Questionnaire for Primary Education (A-EP), and perceived emotional intelligence with the Trait Meta-Mood Scale-24 (TMMS-24). Descriptive statistics, chi-square tests, effect sizes, and Pearson correlation analyses were performed. Results: Moderate bullying involvement was the predominant profile (51.3%), while 12.8% of students presented high bullying levels. Female students reported significantly higher self-esteem (p = 0.022) and emotional intelligence scores (p = 0.012), whereas male students showed greater bullying involvement (p = 0.009). School bullying was negatively correlated with self-esteem (r = −0.42, p < 0.001), emotional attention (r = −0.18, p = 0.002), emotional clarity (r = −0.37, p < 0.001), and emotional repair (r = −0.41, p < 0.001). Self-esteem was positively associated with emotional attention (r = 0.32, p < 0.001), emotional clarity (r = 0.51, p < 0.001), and emotional repair (r = 0.56, p < 0.001). Conclusions: Higher bullying involvement was associated with lower self-esteem and poorer emotional competencies among Primary Education students. These findings support the implementation of school nursing interventions focused on emotional intelligence, self-esteem promotion, and early bullying prevention, highlighting the importance of integrating emotional health strategies into school-based mental health programs.
Abstract: Background: School bullying represents a major public health challenge that negatively affects children's emotional well-being and psychosocial development. Self-esteem and emotional intelligence have been identified as potential protective factors, although evidence from a school nursing perspective in Primary Education remains limited. This study aimed to analyze the relationships between school bullying, self-esteem, and perceived emotional intelligence among Primary Education students, considering gender differences before the implementation of a nurse-led psychoeducational intervention. Methods: A multicenter cross-sectional pretest study was conducted among 507 students from five educational centers in Madrid, Spain. School bullying was assessed using the Peer Harassment Questionnaire (PHQ), self-esteem with the Self-Esteem Questionnaire for Primary Education (A-EP), and perceived emotional intelligence with the Trait Meta-Mood Scale-24 (TMMS-24). Descriptive statistics, chi-square tests, effect sizes, and Pearson correlation analyses were performed. Results: Moderate bullying involvement was the predominant profile (51.3%), while 12.8% of students presented high bullying levels. Female students reported significantly higher self-esteem (p = 0.022) and emotional intelligence scores (p = 0.012), whereas male students showed greater bullying involvement (p = 0.009). School bullying was negatively correlated with self-esteem (r = −0.42, p < 0.001), emotional attention (r = −0.18, p = 0.002), emotional clarity (r = −0.37, p < 0.001), and emotional repair (r = −0.41, p < 0.001). Self-esteem was positively associated with emotional attention (r = 0.32, p < 0.001), emotional clarity (r = 0.51, p < 0.001), and emotional repair (r = 0.56, p < 0.001). Conclusions: Higher bullying involvement was associated with lower self-esteem and poorer emotional competencies among Primary Education students. These findings support the implementation of school nursing interventions focused on emotional intelligence, self-esteem promotion, and early bullying prevention, highlighting the importance of integrating emotional health strategies into school-based mental health programs.
Posted: 25 June 2026
Review
Public Health and Healthcare
Nursing
Relationship Between Depressive Symptoms and Quality of Life in Family Caregivers of Dependent Children: A Systematic Review with Meta-Analysis
Francisco Segura-Galan
,Belén Gutiérrez-Sánchez
,Catalina López-Martínez
,Rafael Del-Pino-Casado
Abstract: Caring for dependent children with chronic illnesses or disabilities is a public health challenge that subjects family caregivers to prolonged physical and emotional stressors. The aim of this study was to quantitatively synthesize the relationship between depressive symptomatology and quality of life in this group. To this end, a systematic review methodology with meta-analysis was used following PRISMA and Cochrane guidelines, consulting databases such as PubMed, CINAHL, PsycInfo and Scopus until February 2026. We included 33 original studies that evaluated family caregivers of children under 18 years of age and provided statistical data of association. The results of the meta-analysis revealed a statistically significant negative association, from moderate to strong, between depressive symptoms and overall quality of life (r = -0.532, maintaining similar values in all the dimensions analyzed (physical, mental, social and environmental) and in the components of the SF-36.In conclusion, this study shows that the increase in depressive symptomatology can severely condition the well-being of family caregivers.
Abstract: Caring for dependent children with chronic illnesses or disabilities is a public health challenge that subjects family caregivers to prolonged physical and emotional stressors. The aim of this study was to quantitatively synthesize the relationship between depressive symptomatology and quality of life in this group. To this end, a systematic review methodology with meta-analysis was used following PRISMA and Cochrane guidelines, consulting databases such as PubMed, CINAHL, PsycInfo and Scopus until February 2026. We included 33 original studies that evaluated family caregivers of children under 18 years of age and provided statistical data of association. The results of the meta-analysis revealed a statistically significant negative association, from moderate to strong, between depressive symptoms and overall quality of life (r = -0.532, maintaining similar values in all the dimensions analyzed (physical, mental, social and environmental) and in the components of the SF-36.In conclusion, this study shows that the increase in depressive symptomatology can severely condition the well-being of family caregivers.
Posted: 22 June 2026
Article
Public Health and Healthcare
Nursing
The Role of Socioeconomic Background in Career Choice and Perceptions of the Graduate Nursing Residency Program Among Nursing Students in Hungary
Edit Nyergesné Závodi
,Viktor Simon
,Krisztina Antónia Bornemissza
,Borbála Mikos
,György János Velkey
,Gusztáv Róbert Stubnya
,Helga Judit Feith
Abstract: Introduction: The current shortage in the global nursing workforce underscores the importance of understanding those factors that influence career choice and professional retention. This study aims to identify the background profiles of Hungarian BSc nursing students based on their social and sociocultural characteristics and to examine their relationship with career choice patterns and perceptions of the Graduate Nursing Residency Program (GNRP). Methods: A cross-sectional quantitative survey was conducted among BSc nursing students at seven Hungarian higher education institutions using an anonymous online questionnaire. The final sample included 971 participants. Student background profiles were identified using TwoStep cluster analysis. Results: Four distinct profiles emerged: students from families with a university degree (17.3%), students with healthcare orientation living in rural areas (37.3%), urban middle-class students (24.2%), and students with an urban mobility background (21.2%). The timing of career choice differed significantly across profiles (p<0.001): 44.2% of students with healthcare orientation residing in rural areas decided on a nursing career during elementary school or earlier. Awareness of the GNRP was limited: 69.7% of the respondents had not previously heard of it. Perceptions of the program’s contribution to professional development varied significantly between profiles (p=0.033), although overall attitudes towards the program were positive. Conclusions: Hungarian BSc nursing students represent a socially heterogeneous population with distinct career choice trajectories. The limited awareness of the GNRP suggests a need for more effective dissemination strategies, while generally positive perceptions indicate the Program’s potential to support workforce retention and early career development.
Abstract: Introduction: The current shortage in the global nursing workforce underscores the importance of understanding those factors that influence career choice and professional retention. This study aims to identify the background profiles of Hungarian BSc nursing students based on their social and sociocultural characteristics and to examine their relationship with career choice patterns and perceptions of the Graduate Nursing Residency Program (GNRP). Methods: A cross-sectional quantitative survey was conducted among BSc nursing students at seven Hungarian higher education institutions using an anonymous online questionnaire. The final sample included 971 participants. Student background profiles were identified using TwoStep cluster analysis. Results: Four distinct profiles emerged: students from families with a university degree (17.3%), students with healthcare orientation living in rural areas (37.3%), urban middle-class students (24.2%), and students with an urban mobility background (21.2%). The timing of career choice differed significantly across profiles (p<0.001): 44.2% of students with healthcare orientation residing in rural areas decided on a nursing career during elementary school or earlier. Awareness of the GNRP was limited: 69.7% of the respondents had not previously heard of it. Perceptions of the program’s contribution to professional development varied significantly between profiles (p=0.033), although overall attitudes towards the program were positive. Conclusions: Hungarian BSc nursing students represent a socially heterogeneous population with distinct career choice trajectories. The limited awareness of the GNRP suggests a need for more effective dissemination strategies, while generally positive perceptions indicate the Program’s potential to support workforce retention and early career development.
Posted: 22 June 2026
Article
Public Health and Healthcare
Nursing
Educational Video on Capillary Blood Glucose Measurement: Development and Validation
Regina Célia dos Santos Diogo
,Rosely da Silva Matos Liberatori
,José Carlos de Santana Neto
,Karoline de Oliveira Lins Souto
,Paula Cristina Nogueira
Abstract: Background: Educational technologies support the development of clinical skills in nursing education, especially in procedures that require technical accuracy and patient safety. This study aimed to develop and validate an educational video for teaching capillary blood glucose measurement to nursing students. Method: A methodological design was used, comprising four stages: conceptualization, development, implementation, and evaluation. Experts (nursing professors and clinical nurses) and users (nursing students) assessed the video regarding objectives, content, usability, and efficiency. The Content Validity Index (CVI) was applied, with CVI ≥ 0.80 considered acceptable. Results: The final product was a video organized into nursing prescription, material preparation, patient approach, capillary blood glucose measurement, disposal, and checking/recording. Filming was conducted by an audiovisual professional, and free software was used for editing and distribution. Subtitles in Portuguese and English were added to enhance accessibility. Thirteen professors/clinical nurses and seventeen students evaluated the material, with all domains achieving CVI ≥ 0.80. Conclusion: The video demonstrated strong content validity and is an effective tool for teaching capillary blood glucose measurement in traditional, digital, and virtual learning environments.
Abstract: Background: Educational technologies support the development of clinical skills in nursing education, especially in procedures that require technical accuracy and patient safety. This study aimed to develop and validate an educational video for teaching capillary blood glucose measurement to nursing students. Method: A methodological design was used, comprising four stages: conceptualization, development, implementation, and evaluation. Experts (nursing professors and clinical nurses) and users (nursing students) assessed the video regarding objectives, content, usability, and efficiency. The Content Validity Index (CVI) was applied, with CVI ≥ 0.80 considered acceptable. Results: The final product was a video organized into nursing prescription, material preparation, patient approach, capillary blood glucose measurement, disposal, and checking/recording. Filming was conducted by an audiovisual professional, and free software was used for editing and distribution. Subtitles in Portuguese and English were added to enhance accessibility. Thirteen professors/clinical nurses and seventeen students evaluated the material, with all domains achieving CVI ≥ 0.80. Conclusion: The video demonstrated strong content validity and is an effective tool for teaching capillary blood glucose measurement in traditional, digital, and virtual learning environments.
Posted: 22 June 2026
Review
Public Health and Healthcare
Nursing
Quality of Life in Patients with Hidradenitis Suppurativa: A Scoping Review
Francesca Gambalunga
,Viviana Lora
,Cristina Marzo
,Simona Molinaro
,Flavia Pantaleo
,Roberto Latina
,Tatiana Bolgeo
,Federica Dellafiore
,Fabrizio Petrone
,Nicolò Panattoni
+1 authors
Abstract: Background/Objectives: Hidradenitis Suppurativa (HS) is a chronic inflammatory skin disease associated with a significant impairment in patients’ quality of life (QoL). However, evidence on QoL assessment in HS remains fragmented, with heterogeneous instruments and domains reported. This scoping review aimed to map the assessment of QoL in individuals with HS, identify the instruments used, and describe the domains explored. Methods: This scoping review was conducted in accordance with the Arksey and O’Malley framework, as refined by Levac et al. and the Joanna Briggs Institute. A systematic search of six databases was performed between November 2025 and March 2026 to identify studies reporting QoL or patient-reported outcomes (PROs) in individuals with HS. Data were extracted and analysed using a narrative synthesis approach. Results: A total of 21 studies met the inclusion criteria. HS was consistently associated with substantial QoL impairment across multiple domains, including physical, psychological, social, sexual, and occupational aspects. Symptom burden was a major determinant of reduced QoL, particularly pain, pruritus, malodor, and discharge. A wide range of instruments was used, with the Dermatology Life Quality Index (DLQI) being the most frequently applied. However, most tools did not adequately capture the multidimensional impact of HS. The use of HS-specific instruments was limited, and most studies adopted cross-sectional designs. Conclusions: QoL in HS is markedly compromised, but current assessment approaches are inconsistent and incomplete. Further research using comprehensive, disease-specific instruments and longitudinal designs is needed to better capture disease burden and support patient-centred care.
Abstract: Background/Objectives: Hidradenitis Suppurativa (HS) is a chronic inflammatory skin disease associated with a significant impairment in patients’ quality of life (QoL). However, evidence on QoL assessment in HS remains fragmented, with heterogeneous instruments and domains reported. This scoping review aimed to map the assessment of QoL in individuals with HS, identify the instruments used, and describe the domains explored. Methods: This scoping review was conducted in accordance with the Arksey and O’Malley framework, as refined by Levac et al. and the Joanna Briggs Institute. A systematic search of six databases was performed between November 2025 and March 2026 to identify studies reporting QoL or patient-reported outcomes (PROs) in individuals with HS. Data were extracted and analysed using a narrative synthesis approach. Results: A total of 21 studies met the inclusion criteria. HS was consistently associated with substantial QoL impairment across multiple domains, including physical, psychological, social, sexual, and occupational aspects. Symptom burden was a major determinant of reduced QoL, particularly pain, pruritus, malodor, and discharge. A wide range of instruments was used, with the Dermatology Life Quality Index (DLQI) being the most frequently applied. However, most tools did not adequately capture the multidimensional impact of HS. The use of HS-specific instruments was limited, and most studies adopted cross-sectional designs. Conclusions: QoL in HS is markedly compromised, but current assessment approaches are inconsistent and incomplete. Further research using comprehensive, disease-specific instruments and longitudinal designs is needed to better capture disease burden and support patient-centred care.
Posted: 22 June 2026
Article
Public Health and Healthcare
Nursing
The Content Validity of the CHANT’s French Translation and Cultural Adaptation: A Modified E-Delphi Study
Omar Portela dos Santos
,Fanny de Hepcée
,Paulo Jorge Pereira Alves
,Henk Verloo
Abstract: Background/Objectives: Climate change is a major global health challenge with direct implications for public health. As frontline health professionals and agents of change, nurses must develop competencies to address climate-related health issues and imple-ment sustainable practices. This study aimed to translate and culturally adapt the Climate, Health, and Nursing Tool (CHANT) into French and to assess its content validity using item-level (I-CVI) and scale-level (S-CVI) indices. The CHANT evaluates nurses’ awareness, motivations, concerns, and self-reported behaviours related to climate change. A secondary objective was to examine potential associations between experts’ socio-demographic and professional characteristics and their CVI ratings. Methods: A de-scriptive international study using a three-round modified e-Delphi approach was conducted between January and June 2025 in French-speaking regions of Switzerland, France, and Belgium. A multidisciplinary panel of experts in nursing, planetary health, and environmental sciences evaluated the relevance, clarity, and comprehensiveness of each item and response option, enabling iterative refinement. Results: Fifty-seven experts assessed the 12-item CHANT across three rounds. In Round 1, I-CVI ranged from 0.79 to 1.0 and S-CVI reached 0.935, with full consensus. In Round 2, I-CVI ranged from 0.71 to 1.0 and S-CVI was 0.91 (92% consensus), with one item not meeting the predefined threshold. In Round 3, I-CVI ranged from 0.82 to 1.0 and S-CVI returned to 0.935, confirming con-sensus. Cognitive debriefing further supported content validity. Conclusions: The val-idated French CHANT provides a robust tool to assess and support the development of climate-related competencies and eco-literacy in nursing education and practice.
Abstract: Background/Objectives: Climate change is a major global health challenge with direct implications for public health. As frontline health professionals and agents of change, nurses must develop competencies to address climate-related health issues and imple-ment sustainable practices. This study aimed to translate and culturally adapt the Climate, Health, and Nursing Tool (CHANT) into French and to assess its content validity using item-level (I-CVI) and scale-level (S-CVI) indices. The CHANT evaluates nurses’ awareness, motivations, concerns, and self-reported behaviours related to climate change. A secondary objective was to examine potential associations between experts’ socio-demographic and professional characteristics and their CVI ratings. Methods: A de-scriptive international study using a three-round modified e-Delphi approach was conducted between January and June 2025 in French-speaking regions of Switzerland, France, and Belgium. A multidisciplinary panel of experts in nursing, planetary health, and environmental sciences evaluated the relevance, clarity, and comprehensiveness of each item and response option, enabling iterative refinement. Results: Fifty-seven experts assessed the 12-item CHANT across three rounds. In Round 1, I-CVI ranged from 0.79 to 1.0 and S-CVI reached 0.935, with full consensus. In Round 2, I-CVI ranged from 0.71 to 1.0 and S-CVI was 0.91 (92% consensus), with one item not meeting the predefined threshold. In Round 3, I-CVI ranged from 0.82 to 1.0 and S-CVI returned to 0.935, confirming con-sensus. Cognitive debriefing further supported content validity. Conclusions: The val-idated French CHANT provides a robust tool to assess and support the development of climate-related competencies and eco-literacy in nursing education and practice.
Posted: 16 June 2026
Article
Public Health and Healthcare
Nursing
Development of a Playful Tool for Managing Friction Injuries: A Methodological Study
Rafael Henrique Marinho
,Edmundo Martins Junior
,Geraldo Magela Salomé
Abstract: Objectives: To design and validate an educational board game aimed at training nurses in the management of friction injuries. Methods: For the development of the game, the Contextualized Instructional Design model was adopted, encompassing the phases of analysis, planning, development, and implementation. Friction Care game content validation involved the participation of 50 expert nurses, through the application of the Delphi Technique. Data analysis was conducted using the Content Validity Coefficient (CVC), with the aim of ensuring the consistency and relevance of the proposed items. Results: In the first evaluation round, the judges rated the game’s content as ranging from “inadequate” to “fully adequate.” After corrections based on the suggestions received, the material was resubmitted for analysis and then considered between “adequate” and “fully adequate.” The CVC ranged from 0.94 to 1.0 in the first evaluation and from 0.99 to 1.0 in the second, demonstrating high agreement among experts regarding the quality of the content. Conclusions: Friction Care game development and validation demonstrated its suitability as an educational resource for training nurses in the management of friction injuries.
Abstract: Objectives: To design and validate an educational board game aimed at training nurses in the management of friction injuries. Methods: For the development of the game, the Contextualized Instructional Design model was adopted, encompassing the phases of analysis, planning, development, and implementation. Friction Care game content validation involved the participation of 50 expert nurses, through the application of the Delphi Technique. Data analysis was conducted using the Content Validity Coefficient (CVC), with the aim of ensuring the consistency and relevance of the proposed items. Results: In the first evaluation round, the judges rated the game’s content as ranging from “inadequate” to “fully adequate.” After corrections based on the suggestions received, the material was resubmitted for analysis and then considered between “adequate” and “fully adequate.” The CVC ranged from 0.94 to 1.0 in the first evaluation and from 0.99 to 1.0 in the second, demonstrating high agreement among experts regarding the quality of the content. Conclusions: Friction Care game development and validation demonstrated its suitability as an educational resource for training nurses in the management of friction injuries.
Posted: 12 June 2026
Article
Public Health and Healthcare
Nursing
“Guardians of Memory”: Psychosocial Barriers to Mental Health Care for Mothers Bereaved by Suicide
Rafailia Zavrou
,Andreas Charalambous
,Evridiki Papastavrou
,Anna Koutroubas
,Maria Karanikola
Abstract: Background/Objectives: While there is an existing body of quantitative data, further qualitative research is needed to explore bereaved mothers’ living experiences in specific sociocultural contexts, especially in Southern Europe and Eastern Mediterranean. Given the persistent stigma surrounding suicide in these societies, and the fact that previous research has often overlooked women’s perspectives in favor of broader samples of bereaved parents, we explored the needs of Greek-speaking suicide-bereaved mothers in the Republic of Cyprus, and the difficulties they face in accessing formal support. Methods: Inductive, secondary content analysis of qualitative data collected through personal interviews with ten mothers was employed. Results: Participants’ needs centered on a “persistent effort for protection,” encompassing three interconnected domains: (1) shielding themselves from stigma, social judgment, and emotional disintegration; (2) safeguarding the psychological well-being and cohesion of surviving family members; and (3) preserving the posthumous dignity and memory of their deceased child. Rather than seeking formal support, participants overwhelmingly avoided mental health services, citing a lack of empathy, cultural misunderstanding, and fear of further stigmatization. Mental health professionals were often perceived as inadequate or even harmful, undermining participants’ need towards protective attitudes, self-reliance and self-respect during bereavement. These responses reflected how stigma and gendered social expectations surrounding suicide shaped participating bereaved mothers’ disengagement from healthcare system, despite their intense psychological needs. Conclusions: These findings underscored how gendered social expectations, combined with the stigma surrounding suicide, created significant psychosocial barriers to mental health care for women navigating traumatic grief, particularly in sociocultural contexts where suicide remains highly stigmatized.
Abstract: Background/Objectives: While there is an existing body of quantitative data, further qualitative research is needed to explore bereaved mothers’ living experiences in specific sociocultural contexts, especially in Southern Europe and Eastern Mediterranean. Given the persistent stigma surrounding suicide in these societies, and the fact that previous research has often overlooked women’s perspectives in favor of broader samples of bereaved parents, we explored the needs of Greek-speaking suicide-bereaved mothers in the Republic of Cyprus, and the difficulties they face in accessing formal support. Methods: Inductive, secondary content analysis of qualitative data collected through personal interviews with ten mothers was employed. Results: Participants’ needs centered on a “persistent effort for protection,” encompassing three interconnected domains: (1) shielding themselves from stigma, social judgment, and emotional disintegration; (2) safeguarding the psychological well-being and cohesion of surviving family members; and (3) preserving the posthumous dignity and memory of their deceased child. Rather than seeking formal support, participants overwhelmingly avoided mental health services, citing a lack of empathy, cultural misunderstanding, and fear of further stigmatization. Mental health professionals were often perceived as inadequate or even harmful, undermining participants’ need towards protective attitudes, self-reliance and self-respect during bereavement. These responses reflected how stigma and gendered social expectations surrounding suicide shaped participating bereaved mothers’ disengagement from healthcare system, despite their intense psychological needs. Conclusions: These findings underscored how gendered social expectations, combined with the stigma surrounding suicide, created significant psychosocial barriers to mental health care for women navigating traumatic grief, particularly in sociocultural contexts where suicide remains highly stigmatized.
Posted: 09 June 2026
Article
Public Health and Healthcare
Nursing
Registered Nurse Prescribing as a Bridge to Nurse Practitioner Readiness: A Comparative Policy Analysis of Alberta and Aotearoa New Zealand with an Illustrative Family‐Medicine Internship Model
Dawid Karczewski
,Tomasz Karczewski
,Jennifer L.M. Stephens
,Merjorie M. A. Pinero
,Avni K. Patel
,Jennifer M. Greenfield
,Mihaela Olsen
Abstract: Background/Objectives: Registered nurse (RN) prescribing can improve timely access to care, but only when the education, authorization process, and workplace supports match the clinical responsibility being given to the nurse. This policy and practice analysis compares Alberta, Canada, with Aotearoa New Zealand, with particular attention to New Zealand registered nurse prescribers in primary health and specialty teams and to RN prescribing as a possible bridge to nurse practitioner (NP) readiness. Methods: We reviewed publicly available legislation, regulator standards, educational frameworks, professional guidance, and institutional information from Alberta/Canada and Aotearoa New Zealand. We also use the publicly described Cranston Ridge Medical Clinic RN Prescriber Internship as an illustrative family-medicine model. No patient, staff, trainee, or private programme data were collected. Results: Alberta permits eligible RNs, when authorized by the College of Registered Nurses of Alberta, to prescribe Schedule 1 drugs, except controlled drugs and substances, and to order common diagnostic tests within a specific practice setting and location. New Zealand uses a postgraduate, practicum-based designated-prescriber pathway for registered nurse prescribers in primary health and specialty teams, with ongoing requirements for prescribing-related professional development and prescribing practice. New Zealand also embeds registered nurse prescribing programme outcomes within NP education standards. Conclusions: Alberta appears to have an enabling legal architecture, but current implementation is site-specific and not formally linked to NP education. We propose a hybrid Alberta-New Zealand-CRMC model built around portable regulator-recognised RN-prescriber authorization, postgraduate prescribing sciences, supervised family-medicine entrustment, employer onboarding, and formal bridging into NP education. The model is presented for policy debate and future evaluation, not as an already tested outcome intervention.
Abstract: Background/Objectives: Registered nurse (RN) prescribing can improve timely access to care, but only when the education, authorization process, and workplace supports match the clinical responsibility being given to the nurse. This policy and practice analysis compares Alberta, Canada, with Aotearoa New Zealand, with particular attention to New Zealand registered nurse prescribers in primary health and specialty teams and to RN prescribing as a possible bridge to nurse practitioner (NP) readiness. Methods: We reviewed publicly available legislation, regulator standards, educational frameworks, professional guidance, and institutional information from Alberta/Canada and Aotearoa New Zealand. We also use the publicly described Cranston Ridge Medical Clinic RN Prescriber Internship as an illustrative family-medicine model. No patient, staff, trainee, or private programme data were collected. Results: Alberta permits eligible RNs, when authorized by the College of Registered Nurses of Alberta, to prescribe Schedule 1 drugs, except controlled drugs and substances, and to order common diagnostic tests within a specific practice setting and location. New Zealand uses a postgraduate, practicum-based designated-prescriber pathway for registered nurse prescribers in primary health and specialty teams, with ongoing requirements for prescribing-related professional development and prescribing practice. New Zealand also embeds registered nurse prescribing programme outcomes within NP education standards. Conclusions: Alberta appears to have an enabling legal architecture, but current implementation is site-specific and not formally linked to NP education. We propose a hybrid Alberta-New Zealand-CRMC model built around portable regulator-recognised RN-prescriber authorization, postgraduate prescribing sciences, supervised family-medicine entrustment, employer onboarding, and formal bridging into NP education. The model is presented for policy debate and future evaluation, not as an already tested outcome intervention.
Posted: 09 June 2026
Article
Public Health and Healthcare
Nursing
Workplace Happiness among Nursing Professionals in Two Spanish Hospitals: A Cross-Sectional Study
Olaya García-Fernández
,Sara Franco-Correia
,María Pilar Mosteiro-Díaz
,Aida Gámez-Fernández
Abstract: Background: Workplace happiness is a multidimensional construct closely linked to professional well-being, job satisfaction, and quality of care in nursing. The scale validated by Ramírez-García et al. (2019) from the original instrument of Del Junco et al. (2013) identifies two underlying factorial dimensions: factors related to the job position (Factor 1) and factors related to the worker as an individual (Factor 2). The aim of this study was to describe workplace happiness in a sample of Spanish nursing professionals and to analyse the sociodemographic and occupational predictors of each factorial dimension.
Methods: A cross-sectional, descriptive observational study (March–April 2024) was conducted among 150 professionals from two hospitals in northern Spain. The 15-item SHAW scale (7-point Likert format) was applied. Both factorial subscales were reconstructed using mean scores weighted by the published factor loadings of Ramírez-García et al. (2019). Kruskal-Wallis, Mann-Whitney U tests and multiple linear regression were performed using 14 sociodemographic and occupational variables as predictors for each factor. Statistical significance was set at p < 0.05.
Results: The mean SHAW total score was 78.33 ± 13.29 (range 32–105). Factor 1 (job position) yielded a mean score of 4.62 ± 1.29, and Factor 2 (worker) of 5.68 ± 1.00. In the regression model for Factor 1 (adjusted R² = 0.112; p = 0.007), work shift (β = −0.500; p = 0.010), informal caregiving role (β = −0.505; p = 0.047) and pharmacological treatment for anxiety or depression (β = −0.982; p = 0.003) were significant predictors. For Factor 2 (adjusted R² = 0.314; p < 0.001), significant predictors were contract type (β = −0.471; p = 0.001), marital status (β = 0.325; p = 0.030), total professional experience (β = 0.036; p = 0.049), seniority in current unit (β = −0.035; p = 0.008) and pharmacological treatment (β = −0.865; p < 0.001).
Conclusions: Workplace happiness in nursing shows a bifactorial profile with differentiated determinants. Organisational and contractual conditions specifically predict job-related factors, while mental health, marital status and professional trajectory determine individual worker well-being. These findings support the need for targeted interventions tailored to each dimension of happiness.
Abstract: Background: Workplace happiness is a multidimensional construct closely linked to professional well-being, job satisfaction, and quality of care in nursing. The scale validated by Ramírez-García et al. (2019) from the original instrument of Del Junco et al. (2013) identifies two underlying factorial dimensions: factors related to the job position (Factor 1) and factors related to the worker as an individual (Factor 2). The aim of this study was to describe workplace happiness in a sample of Spanish nursing professionals and to analyse the sociodemographic and occupational predictors of each factorial dimension.
Methods: A cross-sectional, descriptive observational study (March–April 2024) was conducted among 150 professionals from two hospitals in northern Spain. The 15-item SHAW scale (7-point Likert format) was applied. Both factorial subscales were reconstructed using mean scores weighted by the published factor loadings of Ramírez-García et al. (2019). Kruskal-Wallis, Mann-Whitney U tests and multiple linear regression were performed using 14 sociodemographic and occupational variables as predictors for each factor. Statistical significance was set at p < 0.05.
Results: The mean SHAW total score was 78.33 ± 13.29 (range 32–105). Factor 1 (job position) yielded a mean score of 4.62 ± 1.29, and Factor 2 (worker) of 5.68 ± 1.00. In the regression model for Factor 1 (adjusted R² = 0.112; p = 0.007), work shift (β = −0.500; p = 0.010), informal caregiving role (β = −0.505; p = 0.047) and pharmacological treatment for anxiety or depression (β = −0.982; p = 0.003) were significant predictors. For Factor 2 (adjusted R² = 0.314; p < 0.001), significant predictors were contract type (β = −0.471; p = 0.001), marital status (β = 0.325; p = 0.030), total professional experience (β = 0.036; p = 0.049), seniority in current unit (β = −0.035; p = 0.008) and pharmacological treatment (β = −0.865; p < 0.001).
Conclusions: Workplace happiness in nursing shows a bifactorial profile with differentiated determinants. Organisational and contractual conditions specifically predict job-related factors, while mental health, marital status and professional trajectory determine individual worker well-being. These findings support the need for targeted interventions tailored to each dimension of happiness.
Posted: 09 June 2026
Article
Public Health and Healthcare
Nursing
Safe Minds, Agile Hands: Unpacking the Link Between Psychosocial Safety Climate and Ambidexterity Among Nurses: The Mediating Role of Adaptive Performance
Amal Diab Ghanem Atalla
,Samia Roshdy Soliman Osman
,Heba Ahmed Mohsen Hassen
,Ebaa M. Felemban
,Ohood Felemban
,Makiah Mohammed Shebaili
,Asmaa Hany Fathallaa
,Marwa Samir Sorour
,Ghada Mohamed Hamouda
,Samia Mohamed Sobhi Mohamed
+1 authors
Abstract: Background/ Objective: Healthcare institutions may foster environments that support nurses’ professional and personal growth. Therefore, nurses and healthcare facilities must provide a psychologically secure workplace. The purpose of the study is to investigate the relationship between nurses’ psychological safety atmosphere and ambidexterity, as well as the mediating function of adaptive performance. Methods: This investigation employed a descriptive correlational research design, following the STROBE criteria. To retain practical feasibility and guarantee adequate power to identify mediation effects, a target sample of roughly 400 nurses was established from Alexandria Main University Hospital, the largest academic hospital in Egypt, which is connected to Alexandria University, and was judged sufficient to meet the structural equation modeling (SEM) standards. The data gathering approach included three validated instruments: adaptable performance, ambidexterity behavior, and psychosocial safety climate (PSC). Results: Individual ambidexterity (β = 0.130, p = 0.025) and adaptive performance (β = 0.785, p < 0.001) were both strongly impacted by the psychological safety environment. Adaptive performance was a significant predictor of individual ambidexterity (β = 0.536, p < 0.001). Additionally, adaptive performance significantly moderates the relationship between individual ambidexterity and the psychological safety environment, according to a substantial indirect impact (β = 0.421). A satisfactory match was shown by the model fit indices (p < 0.001, CFI = 0.961, IFI = 0.950, RMSEA = 0.072, χ²/df = 9.239/3). Conclusions: psychosocial safety atmosphere greatly improves individual ambidexterity and adaptive performance, underscoring its role in developing a workforce that can successfully navigate between exploration and exploitation tasks while adapting to changing circumstances.
Abstract: Background/ Objective: Healthcare institutions may foster environments that support nurses’ professional and personal growth. Therefore, nurses and healthcare facilities must provide a psychologically secure workplace. The purpose of the study is to investigate the relationship between nurses’ psychological safety atmosphere and ambidexterity, as well as the mediating function of adaptive performance. Methods: This investigation employed a descriptive correlational research design, following the STROBE criteria. To retain practical feasibility and guarantee adequate power to identify mediation effects, a target sample of roughly 400 nurses was established from Alexandria Main University Hospital, the largest academic hospital in Egypt, which is connected to Alexandria University, and was judged sufficient to meet the structural equation modeling (SEM) standards. The data gathering approach included three validated instruments: adaptable performance, ambidexterity behavior, and psychosocial safety climate (PSC). Results: Individual ambidexterity (β = 0.130, p = 0.025) and adaptive performance (β = 0.785, p < 0.001) were both strongly impacted by the psychological safety environment. Adaptive performance was a significant predictor of individual ambidexterity (β = 0.536, p < 0.001). Additionally, adaptive performance significantly moderates the relationship between individual ambidexterity and the psychological safety environment, according to a substantial indirect impact (β = 0.421). A satisfactory match was shown by the model fit indices (p < 0.001, CFI = 0.961, IFI = 0.950, RMSEA = 0.072, χ²/df = 9.239/3). Conclusions: psychosocial safety atmosphere greatly improves individual ambidexterity and adaptive performance, underscoring its role in developing a workforce that can successfully navigate between exploration and exploitation tasks while adapting to changing circumstances.
Posted: 04 June 2026
Review
Public Health and Healthcare
Nursing
Use of Chatbots and Virtual Assistant Tools as Support in the Pregnancy-Puerperal Cycle: Narrative Review Literature
Gustavo Gonçalves dos Santos
,Anna Paula Mendes Marques de Lima Franco
,Francini Castilha do Nascimento
,Letícia Eduarda de Oliveira
,Maria Julia Cunha Silva Lima
,Joaquim Guerra de Oliveira Neto
,Wágnar Silva Morais Nascimento
,Marcelo Víctor Freitas Nascimento
,Pedro Vitor Mendes Santos
,Leticia de Almeida Dionizio
+5 authors
Abstract: Background: The use of digital health technologies, such as chatbots and virtual assistants based on artificial intelligence, has grown significantly in maternal health. These tools have been applied at different stages of the pregnancy and postpartum cycle, with emphasis on health education, risk monitoring, breastfeeding support, and mental health care. Despite their potential, challenges remain regarding clinical effectiveness, equity of access, and ethical safety. To describe, through a narrative literature review, the use of chatbots, conversational agents, and virtual assistants as support during pregnancy, childbirth, and the postpartum period, identifying applications, benefits, limitations, and perspectives for health practice. Methods: A narrative literature review was conducted between August and September 2025 in PubMed, Scopus, Web of Science, Nursing Database, Latin American and Caribbean Literature in Health Sciences and Google Scholar. Original articles, reviews, experience reports, and theoretical reflections published in Portuguese, English, or Spanish that addressed the use of digital tools based on artificial intelligence in the pregnancy and postpartum cycle were included. The analysis of the studies was organized into five thematic axes: applications in prenatal care, support during childbirth, postpartum monitoring and breastfeeding, perinatal mental health, and ethical, technical, and implementation challenges. Results: The search identified 6,230 records, of which 13 studies were included. Findings indicate that chatbots and virtual assistants show good acceptability, promote health education, and contribute to the early detection of physical and emotional risks. However, most of the studies are exploratory, with methodological limitations, lack of clinical trials, and limited validation in socially vulnerable contexts. Conclusions: Chatbots and artificial intelligence tools are promising resources for perinatal care, particularly as a complement to face-to-face attention. Their consolidation requires robust studies, cost-effectiveness assessments, and public policies that ensure equity and digital inclusion.
Abstract: Background: The use of digital health technologies, such as chatbots and virtual assistants based on artificial intelligence, has grown significantly in maternal health. These tools have been applied at different stages of the pregnancy and postpartum cycle, with emphasis on health education, risk monitoring, breastfeeding support, and mental health care. Despite their potential, challenges remain regarding clinical effectiveness, equity of access, and ethical safety. To describe, through a narrative literature review, the use of chatbots, conversational agents, and virtual assistants as support during pregnancy, childbirth, and the postpartum period, identifying applications, benefits, limitations, and perspectives for health practice. Methods: A narrative literature review was conducted between August and September 2025 in PubMed, Scopus, Web of Science, Nursing Database, Latin American and Caribbean Literature in Health Sciences and Google Scholar. Original articles, reviews, experience reports, and theoretical reflections published in Portuguese, English, or Spanish that addressed the use of digital tools based on artificial intelligence in the pregnancy and postpartum cycle were included. The analysis of the studies was organized into five thematic axes: applications in prenatal care, support during childbirth, postpartum monitoring and breastfeeding, perinatal mental health, and ethical, technical, and implementation challenges. Results: The search identified 6,230 records, of which 13 studies were included. Findings indicate that chatbots and virtual assistants show good acceptability, promote health education, and contribute to the early detection of physical and emotional risks. However, most of the studies are exploratory, with methodological limitations, lack of clinical trials, and limited validation in socially vulnerable contexts. Conclusions: Chatbots and artificial intelligence tools are promising resources for perinatal care, particularly as a complement to face-to-face attention. Their consolidation requires robust studies, cost-effectiveness assessments, and public policies that ensure equity and digital inclusion.
Posted: 03 June 2026
Review
Public Health and Healthcare
Nursing
Challenges And Enablers Of Expat Nurses While Providing End-Of-Life Care In Gulf Countries: A Systematic Review
Arsheen Sajwani
,Rami Eid Samarah
,Mohammad Alshdaifat
,Eman Fawzy Abdalla Abdelghany
,Romario Abou Chedid
,Ibrahim Alananzeh
Abstract: Objective: Expatriate nurses constitute a large proportion of the healthcare workforce in many Middle Eastern countries, including Saudi Arabia. Providing end-of-life (EOL) care in culturally diverse environments can present significant challenges, particularly when linguistic, cultural, and religious differences influence communication and decision-making processes. Understanding these challenges is essential to improving culturally responsive EOL care. Methods: A mixed-methods systematic review was conducted to synthesise evidence on expatriate nurses’ experiences of providing end-of-life care in Middle Eastern healthcare settings. Electronic databases were searched for relevant studies, and eligible studies were selected based on predefined inclusion criteria. Methodological quality of the included studies was assessed using appropriate appraisal tools. Data were extracted and synthesised using a narrative thematic approach to integrate qualitative and quantitative findings. Results: Nine studies met the inclusion criteria and were included in the review. The synthesis identified five major themes influencing expatriate nurses’ experiences of providing EOL care: communication barriers, cultural and religious challenges, organisational and structural constraints, the role of families in decision-making, and compassionate care and professional coping strategies. Language discordance, particularly limited Arabic proficiency, emerged as a major barrier affecting communication with patients and families. Cultural expectations surrounding family involvement and religious practices also influenced nurses’ ability to navigate EOL discussions. Organisational factors such as heavy workloads and limited palliative care training further constrained the delivery of holistic care. This review highlights the complex linguistic, cultural, and organisational factors affecting expatriate nurses’ ability to deliver effective end-of-life care in Middle Eastern healthcare settings. Strengthening language support systems, enhancing cultural competence training, and improving institutional support mechanisms may help improve the quality of EOL care for culturally diverse patient populations.
Abstract: Objective: Expatriate nurses constitute a large proportion of the healthcare workforce in many Middle Eastern countries, including Saudi Arabia. Providing end-of-life (EOL) care in culturally diverse environments can present significant challenges, particularly when linguistic, cultural, and religious differences influence communication and decision-making processes. Understanding these challenges is essential to improving culturally responsive EOL care. Methods: A mixed-methods systematic review was conducted to synthesise evidence on expatriate nurses’ experiences of providing end-of-life care in Middle Eastern healthcare settings. Electronic databases were searched for relevant studies, and eligible studies were selected based on predefined inclusion criteria. Methodological quality of the included studies was assessed using appropriate appraisal tools. Data were extracted and synthesised using a narrative thematic approach to integrate qualitative and quantitative findings. Results: Nine studies met the inclusion criteria and were included in the review. The synthesis identified five major themes influencing expatriate nurses’ experiences of providing EOL care: communication barriers, cultural and religious challenges, organisational and structural constraints, the role of families in decision-making, and compassionate care and professional coping strategies. Language discordance, particularly limited Arabic proficiency, emerged as a major barrier affecting communication with patients and families. Cultural expectations surrounding family involvement and religious practices also influenced nurses’ ability to navigate EOL discussions. Organisational factors such as heavy workloads and limited palliative care training further constrained the delivery of holistic care. This review highlights the complex linguistic, cultural, and organisational factors affecting expatriate nurses’ ability to deliver effective end-of-life care in Middle Eastern healthcare settings. Strengthening language support systems, enhancing cultural competence training, and improving institutional support mechanisms may help improve the quality of EOL care for culturally diverse patient populations.
Posted: 27 May 2026
Article
Public Health and Healthcare
Nursing
Health-Promoting Lifestyle Profiles, Academic Stress, and Health-Professional Advice Seeking among Undergraduate Nursing Students: A Cross-Sectional Study
Alexis Emmanuel Salinas-Santoyo
,Gabriela Luna-Hernández
,Victor Horacio Orozco-Covarrubias
,Janvier Andre Martinez-Godinez
,Jaime Briseno-Ramírez
,Cecilia Alejandra Zamora Figueroa
Abstract: Undergraduate nursing students are trained to promote health in clinical and community settings, but their own health-promoting behaviors occur in the context of academic demands, clinical training, work responsibilities, and limited time for self-care. This cross-sectional analytic study described health-promoting lifestyles among 506 undergraduate nursing students at the Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara; assessed internal consistency, factorability, and exploratory dimensional evidence for the Health-Promoting Lifestyle Profile II (HPLP-II); identified empirical lifestyle profiles; and examined cross-sectional associations of perceived stress, health-professional advice seeking, and health-information sources with HPLP-II scores. The overall median HPLP-II score was 2.40 (IQR: 2.06, 2.79). Internal consistency was high for the global scale (Cronbach’s alpha = 0.961) and ranged from acceptable to high across subscales (alpha = 0.812–0.900). Two lifestyle profiles were identified: Low HPLP (58.1%) and High HPLP (41.9%). In the primary HC3 robust model, health-professional advice seeking was associated with higher global HPLP-II scores (beta = 0.242, 95% CI: 0.140, 0.344; p < 0.001), whereas academic stress and vacation-period stress showed small inverse adjusted associations with HPLP-II scores. Sensitivity analyses, including IPTW, a modified HPLP-II score excluding Health Responsibility, and a model excluding willingness to improve lifestyle, showed advice-seeking coefficients in the same positive direction. The exploratory stress-by-advice-seeking interaction was not statistically significant. Findings should be interpreted as associations rather than causal effects.
Abstract: Undergraduate nursing students are trained to promote health in clinical and community settings, but their own health-promoting behaviors occur in the context of academic demands, clinical training, work responsibilities, and limited time for self-care. This cross-sectional analytic study described health-promoting lifestyles among 506 undergraduate nursing students at the Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara; assessed internal consistency, factorability, and exploratory dimensional evidence for the Health-Promoting Lifestyle Profile II (HPLP-II); identified empirical lifestyle profiles; and examined cross-sectional associations of perceived stress, health-professional advice seeking, and health-information sources with HPLP-II scores. The overall median HPLP-II score was 2.40 (IQR: 2.06, 2.79). Internal consistency was high for the global scale (Cronbach’s alpha = 0.961) and ranged from acceptable to high across subscales (alpha = 0.812–0.900). Two lifestyle profiles were identified: Low HPLP (58.1%) and High HPLP (41.9%). In the primary HC3 robust model, health-professional advice seeking was associated with higher global HPLP-II scores (beta = 0.242, 95% CI: 0.140, 0.344; p < 0.001), whereas academic stress and vacation-period stress showed small inverse adjusted associations with HPLP-II scores. Sensitivity analyses, including IPTW, a modified HPLP-II score excluding Health Responsibility, and a model excluding willingness to improve lifestyle, showed advice-seeking coefficients in the same positive direction. The exploratory stress-by-advice-seeking interaction was not statistically significant. Findings should be interpreted as associations rather than causal effects.
Posted: 26 May 2026
Article
Public Health and Healthcare
Nursing
Workplace Violence in Nursing: Prevalence and Nature of Incidents in a Tertiary University Hospital
Fabio Silva da Rosa
,Mara Ambrosina de Oliveira Vargas
,Daiane Dal Pai
,Rosinei Nascimento Ferreira
,Davydson Gouveia Santos
,Rafael Limeira Freitas
,Maria de Nazaré de Souza Ribeiro
,Laura Cavalcante de Farias Brehmer
,José Luiz Guedes dos Santos
,Elaine Cristina Novatzki Fortes
Abstract: The prevalence of workplace violence in nursing represents a growing challenge for workers’ health and for the quality of care. This study aimed to analyze the prevalence and nature of workplace violence incidents experienced by nursing professionals in a tertiary-level university hospital. This is a cross-sectional, exploratory, and descriptive study conducted with 573 professionals, using an electronic form for data collection. Descriptive and inferential analyses were performed using the chi-square test with Bonferroni correction. Among participants, 71.2% reported having experienced violence in the workplace, with moral harassment/intimidation (76.5%), verbal violence (49.8%), and psychological violence (43.9%) standing out. Physical violence (8.1%), sexual violence (5.6%), racial discrimination (9.1%), gender discrimination (6.4%), ageism (7.8%), and ableism (2.0%) occurred less frequently. Leaders (37.3%), family members/companions (29.4%), and coworkers (28.4%) were identified as the main aggressors. Violence resulted in significant impacts, including medication use, seeking psychological treatment, work absences, intention to resign (50.2%), and intention to change professions (42.6%). Underreporting was high, with only 33.7% of incidents formally recorded. The study concludes that workplace violence is multifaceted and widespread, affecting the health, well-being, and performance of professionals, reinforcing the urgency of institutional strategies for prevention and support within the hospital environment.
Abstract: The prevalence of workplace violence in nursing represents a growing challenge for workers’ health and for the quality of care. This study aimed to analyze the prevalence and nature of workplace violence incidents experienced by nursing professionals in a tertiary-level university hospital. This is a cross-sectional, exploratory, and descriptive study conducted with 573 professionals, using an electronic form for data collection. Descriptive and inferential analyses were performed using the chi-square test with Bonferroni correction. Among participants, 71.2% reported having experienced violence in the workplace, with moral harassment/intimidation (76.5%), verbal violence (49.8%), and psychological violence (43.9%) standing out. Physical violence (8.1%), sexual violence (5.6%), racial discrimination (9.1%), gender discrimination (6.4%), ageism (7.8%), and ableism (2.0%) occurred less frequently. Leaders (37.3%), family members/companions (29.4%), and coworkers (28.4%) were identified as the main aggressors. Violence resulted in significant impacts, including medication use, seeking psychological treatment, work absences, intention to resign (50.2%), and intention to change professions (42.6%). Underreporting was high, with only 33.7% of incidents formally recorded. The study concludes that workplace violence is multifaceted and widespread, affecting the health, well-being, and performance of professionals, reinforcing the urgency of institutional strategies for prevention and support within the hospital environment.
Posted: 26 May 2026
Article
Public Health and Healthcare
Nursing
Skin-to-Skin Contact After Cesarean Sections: Implementation Of a Research Guide and a Protocol
Jose Miguel Pérez-Jiménez
,Miriam Fernández Rodríguez
,Thalía Flores Alpresa
,Juan Vega Escaño
,Estefania Bautista Valarezo
,Rocío De Diego-Cordero
Abstract: Background/Objectives: Despite its proven benefits for mother and newborn, skin-to-skin contact (SSC) following a caesarean section faces significant organisational and professional obstacles in clinical settings. This descriptive qualitative study aimed to identify the barriers and facilitators experienced by multidisciplinary healthcare teams implementing SSC, using this frontline evidence to design a standardised hospital-wide protocol. Methods: Following phenomenological approaches and COREQ guidelines, forty semi-structured interviews were conducted at a Spanish tertiary hospital. Partici-pants included professionals directly involved in the caesarean care pathway: anaest-hesiologists, gynaecologists, neonatologists, midwives, nurses, and nursing assistants. The collected data underwent thematic categorisation at semantic and pragmatic levels using MAXQDA software. Results: Analysis revealed several overarching barriers hin-dering SSC implementation. Institutional obstacles included understaffing, inadequate physical infrastructure, and the absence of specific guidelines. Professional challenges involved knowledge gaps, limited training, and resistance rooted in established routines. Furthermore, attitudinal barriers emerged from uncertainty regarding the safety of caesarean following major abdominal surgery. Conversely, key facilitators encompassed the absence of clinical complications and the profound emotional impact of SSC, which greatly enhances bonding and family-centred connection. Crucially, these qualitative findings directly informed the successful deployment of an operational hospital-wide SSC protocol. Conclusions: Although caesarean SSC is safe, feasible, and deeply valued by families, it remains systematically underimplemented due to addressable barriers. Scaling this practice requires targeted training, multidisciplinary commitment, and in-frastructural adaptations in recovery rooms. Such investments are fully justified by the extensive clinical benefits for maternal and neonatal well-being.
Abstract: Background/Objectives: Despite its proven benefits for mother and newborn, skin-to-skin contact (SSC) following a caesarean section faces significant organisational and professional obstacles in clinical settings. This descriptive qualitative study aimed to identify the barriers and facilitators experienced by multidisciplinary healthcare teams implementing SSC, using this frontline evidence to design a standardised hospital-wide protocol. Methods: Following phenomenological approaches and COREQ guidelines, forty semi-structured interviews were conducted at a Spanish tertiary hospital. Partici-pants included professionals directly involved in the caesarean care pathway: anaest-hesiologists, gynaecologists, neonatologists, midwives, nurses, and nursing assistants. The collected data underwent thematic categorisation at semantic and pragmatic levels using MAXQDA software. Results: Analysis revealed several overarching barriers hin-dering SSC implementation. Institutional obstacles included understaffing, inadequate physical infrastructure, and the absence of specific guidelines. Professional challenges involved knowledge gaps, limited training, and resistance rooted in established routines. Furthermore, attitudinal barriers emerged from uncertainty regarding the safety of caesarean following major abdominal surgery. Conversely, key facilitators encompassed the absence of clinical complications and the profound emotional impact of SSC, which greatly enhances bonding and family-centred connection. Crucially, these qualitative findings directly informed the successful deployment of an operational hospital-wide SSC protocol. Conclusions: Although caesarean SSC is safe, feasible, and deeply valued by families, it remains systematically underimplemented due to addressable barriers. Scaling this practice requires targeted training, multidisciplinary commitment, and in-frastructural adaptations in recovery rooms. Such investments are fully justified by the extensive clinical benefits for maternal and neonatal well-being.
Posted: 25 May 2026
Review
Public Health and Healthcare
Nursing
The Coach/Player Relationship: Coaching New Nursing Faculty on
Their Journey to Success in Higher Education
Jason R. Thrift
Abstract: Aim: To describe and propose the implementation of a 1:1 coaching model.
Background: The nursing faculty shortage has become a significant factor in maintaining qualified educators, but little is known about specific strategies to retain them. A Coach/Player model can this relationship, creating zones where the experienced and novice faculty can share in each other's successes equally.
Innovation: The coach and player worked together, assigned to teach multiple sections of a nursing course. The coach and player met 1-2 times per week virtually to prepare material and debrief on the previous week's course lecture, promoting confidence and ensuring continuity between the course sections.
Implications: The player reported high satisfaction with their work environment and felt supported and valued, while the coach perceived satisfaction in passing their knowledge on to the player.
Conclusion: Implementing the coach/player model is a promising strategy to promote retention, confidence, and success in novice nurse educators.
Abstract: Aim: To describe and propose the implementation of a 1:1 coaching model.
Background: The nursing faculty shortage has become a significant factor in maintaining qualified educators, but little is known about specific strategies to retain them. A Coach/Player model can this relationship, creating zones where the experienced and novice faculty can share in each other's successes equally.
Innovation: The coach and player worked together, assigned to teach multiple sections of a nursing course. The coach and player met 1-2 times per week virtually to prepare material and debrief on the previous week's course lecture, promoting confidence and ensuring continuity between the course sections.
Implications: The player reported high satisfaction with their work environment and felt supported and valued, while the coach perceived satisfaction in passing their knowledge on to the player.
Conclusion: Implementing the coach/player model is a promising strategy to promote retention, confidence, and success in novice nurse educators.
Posted: 22 May 2026
of 28
