Public Health and Healthcare

Abstract: Background: Advance care planning (ACP) enables individuals to communicate values and preferences for future care before decisional capacity is lost. Although ACP is particularly important for people living with mild cognitive impairment (MCI) and dementia, engagement remains low, and the mechanisms underlying this gap are not well understood. This qualitative evidence synthesis examined perceived barriers to ACP among people living with dementia and their family caregivers.Methods: Four were searched from database inception to July 1st 2026, for qualitative studies reporting barriers to ACP among people with MCI or dementia and/or family caregivers. Twenty-four studies conducted across ten countries met inclusion criteria. Barrier statements extracted from included studies were analyzed using thematic synthesis, generating 25 codes grouped into descriptive themes and further abstracted into analytical themes representing dementia-specific mechanisms.Results: Two analytical themes were identified: (1) challenges in preserving the person's voice throughout the dementia trajectory, reflecting a shift toward caregiver-mediated decision-making, assumptions about capacity, and delayed ACP initiation; and (2) challenges in maintaining continuity of expressed values and preferences over time, reflecting uncertainty about future care needs and the limitations of one-time ACP conversations. Three contextual barriers, including limited ACP preparedness, insufficient healthcare professional and system support, and sociocultural influences, further shaped engagement. Methodological quality across included studies was high.Conclusion: ACP in dementia is shaped by challenges extending beyond commonly reported general-population barriers. Effective support for this population requires moving beyond one-time, capacity-focused documentation toward ongoing, relationally embedded approaches to communication and values clarification throughout the disease trajectory.

Abstract: Introduction: The diagnosis and evolution of cancer generate a multidimensional impact (physical, psychological, emotional, social, and spiritual) on the patient. Some active treatments entail long stays in the day hospital, which can deteriorate patients' quality of life. Objective: To analyze the effectiveness of a live music session in cancer patients under active treatment. Specifically, its impact on anxiety, treatment-related symptoms, satisfaction, and perception of session duration was assessed. Method: A non-randomized controlled trial of two parallel arms with pre-post measurement was conducted in patients with active intravenous cancer treatment at the University Hospital of Jaén (n = 125; GI = 60; CG = 65). Results: The findings reflect that the intervention group significantly reduced the need for nursing care (OR = 0.89; 95% CI: 0.82 - 0.97) and perceived that the treatment proceeded faster (OR = 4.60; 95% CI: 1.80 - 11.79). Likewise, the assessment that the infusion was more enjoyable was significantly higher in the intervention group compared to the control group (3.78 ± 0.98 vs. 3.08 ± 0.71; p < 0.001). No significant differences in anxiety were achieved. Conclusion: A single live music session makes the treatment be perceived as shorter and more enjoyable; in addition to a favorable clinical trend toward better tolerance of cancer treatment.

Abstract: Background/Objectives: Burnout can undermine nurses’ well-being and contribute to turnover intention, yet evidence from governmental hospitals in Makkah is limited. This study assessed turnover intention and burnout and examined their relationships with demographic and work-related characteristics. Methods: A cross-sectional correlational survey was conducted during the first quarter of 2024 among 365 registered nurses recruited from governmental hospitals in Makkah through snowball sampling. Turnover intention was measured with the 12-item Anticipated Turnover Scale, and burnout was assessed with the 22-item Maslach Burnout Inventory. Descriptive statistics, chi-square tests with Cramer’s V, and Pearson correlations were used. Results: Mean turnover intention was moderate (51.92). Emotional exhaustion was low (17.78), depersonalization was high (27.84), and personal accomplishment was low (6.57). Turnover intention was positively correlated with emotional exhaustion (r = 0.127, p = 0.016), depersonalization (r = 0.283, p &lt; 0.001), and the reported overall burnout score (r = 0.235, p &lt; 0.001), but not personal accomplishment (r = 0.083, p = 0.113). No demographic or work-related characteristic was significantly associated with turnover intention. Several characteristics were associated with burnout dimensions, although these subgroup findings require caution because of sparse categories and multiple comparisons. Conclusions: Burnout dimensions, particularly depersonalization, were associated with greater turnover intention. Organizational strategies addressing workload, staff support, and professional well-being may help strengthen nurse retention.

Abstract: Background: Carpal tunnel syndrome (CTS) is a common condition in the third trimester due to hormonal changes, fluid retention, and weight gain, and is associated with pain, numbness, and impaired hand function. Home-based exercise programs support symptom relief, adherence, and continuous remote monitoring. Aim: To evaluate the effect of a home-based exercise protocol on pain and hand function among pregnant women with de novo carpal tunnel syndrome. Methods: A pre-experimental design (one-group pretest–posttest design) was utilized in the present study. A purposive sample of 50 pregnant women diagnosed with de novo CTS was recruited from outpatient prenatal clinics at Minia University Hospital for Maternity and Children. Data were collected using a structured interview questionnaire, the Boston Carpal Tunnel Syndrome Questionnaire, the Numerical Pain Rating Scale, and the Women’s Satisfaction Likert Scale. Participants followed a structured home-based exercise protocol comprising hand and wrist exercises, stretching and strengthening exercises, and wrist splint use, practiced regularly at home. Pain intensity, symptom severity, and hand function were assessed before and after the intervention. Results: The mean age was 31.75 ± 12.46 years and mean gestational age was 31.2 ± 4.3 weeks. Wrist pain, symptom severity, and hand function improved significantly after the intervention (p <0 .001). Mean symptom severity score decreased from 4.20 ± 0.79 to 1.76 ± 0.76, and mean functional status score decreased from 4.12 ± 0.75 to 1.71 ± 0.72. Exercise adherence was strongly negatively correlated with symptom severity (r = −.894, p = .001) and functional impairment (r = −.887, p = 0.001). Overall, 88% of participants reported high satisfaction with the intervention. Conclusion: A home-based exercise protocol significantly reduced pain and symptom severity and improved hand function in pregnant women with de novo CTS, with high adherence-linked benefit and participant satisfaction. Nurses can integrate structured, remotely monitored exercise protocols into routine prenatal care for CTS management.

Abstract: Background/Objectives: Physical activity is an important component of type 2 diabetes (T2DM) management, and nurses are well-positioned to promote it in routine care. However, little is known about its implementation by diabetes nurses working in primary healthcare in Bahrain. This study examined nurses’ perceptions, confidence, knowledge, awareness, guideline awareness and use, promotion practices, and perceived barriers to physical activity. Methods: A national cross-sectional mixed methods study was conducted among primary healthcare nurses. All 52 eligible nurses were invited to participate, with 49 completing an online questionnaire. Quantitative data were analysed using descriptive and exploratory statistics, and free-text responses using inductive thematic analysis. Results: Nurses strongly perceived physical activity promotion to be part of their professional role and reported high confidence in providing advice. However, 44.9% were aware of at least one physical activity guideline and 24.4% reported both awareness and routine use. Only 34.7% reported always assessing patients’ physical activity irrespective of presenting health needs. Nurses reported that the most commonly perceived barriers among people in Bahrain were lack of time (83.7%) and lack of motivation and support from family and friends (67.3%). Qualitative findings identified four themes: public awareness and health education; access to physical activity facilities and opportunities; motivation and behavioural support; and healthcare and community support. Conclusions: Diabetes nurses in Bahrain demonstrated a strong professional commitment to promoting physical activity, but this was not consistently reflected in systematic, guideline-informed practice. Greater awareness and implementation of existing guidance, practical approaches to physical activity assessment, clearer referral pathways, and coordinated healthcare and community support may strengthen physical activity promotion.

Abstract: Background: The post-pandemic academic landscape has witnessed a significant rise in mental health challenges among higher education students. While general psychological distress is widely acknowledged, a comprehensive synthesis evaluating the specific prevalence of anxiety, depression, and stress alongside contemporary pro-active self-care and institutional stress-management interventions remains critical. This paper analyzes the global burden of student psychopathology and evaluates the clinical utility of modern preventive frameworks. Methods: A critical synthesis was conducted utilizing recent large-scale meta-analytic data, randomized controlled trials, and observational studies (2024–2026) focusing on university cohorts, specifically healthcare and medical tracks. The analysis examined overall prevalence rates, situation-specific constructs (e.g., test anxiety), and the efficacy of modern stress-management modalities (Mindfulness-Based Stress Reduction [MBSR], resilience training, and the Information-Motivation-Behavioral Skills [IMB] model) across traditional and digital formats. Results: Global meta-analytic data establishes a severe post-pandemic mental health burden, with a pooled prevalence of 45.1% for depression, 43.6% for anxiety, and 45.6% for general stress among university students. Within highly specialized medical cohorts, situation-specific test anxiety isolates a critical sub-threshold affecting 49.8% of students globally. While digital self-help technologies offer scalability, attitudinal evaluations show that students heavily favor face-to-face or blended care models over solo digital interventions due to the perceived credibility of interpersonal support. Theory-driven, multi-construct programs like the IMB model and structured resilience training show the highest clinical efficacy in mitigating academic burnout. Conclusions: Student psychological distress is a systemic institutional issue rather than a localized individual failure. Higher education institutions must transition from reactive counseling to proactive, preventative mental health architectures by integrating structured self-care education and blended counseling models directly into the core academic curricula.

Abstract: Background: Pre-eclampsia remains a leading cause of maternal and perinatal morbidity and mortality worldwide, with a disproportionately high burden in low- and middle-income countries. Nurses are often the first healthcare providers to encounter pregnant women in obstetric emergency settings, making their knowledge of pre-eclampsia management critical for timely intervention and prevention of complications.Objective: To assess nurses’ knowledge regarding the management of pre-eclampsia at Rangpur Community Medical College Hospital, Rangpur, Bangladesh.Methods: A descriptive cross-sectional study was conducted among 50 senior staff nurses working in the Gynaecology, Obstetrics, Labour, and CCU/ICU wards from January to June 2026. A purposive sampling technique was employed, and data were collected us-ing a self-administered structured questionnaire comprising 20 knowledge-related items. Knowledge levels were categorized as high (16–20), moderate (10–15), and low (0–9). Data were analyzed using SPSS version 20, with descriptive statistics and Chi-square tests applied.Results: The majority of respondents were aged 26–30 years (n=9 at age 26), female (80.0%), married (68.0%), and from rural areas (78.0%). Most were Muslim (90.0%), held a B.Sc. in Nursing (60.0%), and worked in the Obstetrics ward (38.0%). Overall, 50.0% demonstrated high knowledge, 46.0% moderate knowledge, and 4.0% low knowl-edge. High knowledge was observed in identifying labetalol as first-line antihypertensive (98.0%), 24-hour urine protein as the most indicative diagnostic test (100%), and ensuring airway patency during seizures (84.0%). However, significant gaps were identified: only 22.0% correctly identified seizure prevention as the goal of magnesium sulfate therapy, and only 16.0% knew calcium gluconate as the antidote for magnesium toxicity. Chi-square analysis revealed a statistically significant association between working department andknowledge level (χ2 = 22.159, df=6, p = .001), but no significant association between academic qualification and knowledge level (χ2 = 3.004, df=2, p = .223).Conclusion: While the majority of nurses demonstrated satisfactory overall knowledge, critical gaps exist regarding magnesium sulfate therapy and toxicity management. Targeted educational interventions and continuous professional development are urgently needed to strengthen nurses’ competence in pre-eclampsia management.

Abstract: Nursing students often face incivility during clinical placements while applying their classroom learning in real-world settings under the supervision of registered nurses. These experiences can be particularly challenging for students who are young and lack professional experience, leaving them vulnerable to stress and feelings of isolation, potentially affecting students’ self-efficacy in managing tasks and challenges. This study explored the relationship between nursing students’ experiences of workplace incivility and perceptions of their self-efficacy when dealing with workplace incivility. A cross-sectional survey was conducted between August 2020 and January 2021 with 244 domestic and international nursing students who had completed at least one clinical placement, to measure the prevalence of incivility and students’ perceived self-efficacy in managing such experiences. Descriptive and bivariate analysis using Spearman’s rank correlation and the Mann-Whitney U test were conducted. Findings indicated that nursing students experienced high levels of incivility, which had a significant, moderate inverse relationship with self-efficacy, and a positive relationship with clinical placements. Domestic students reported significantly higher levels of incivility, while international students demonstrated significantly higher self-efficacy. Students with prior healthcare employment experienced significantly higher levels of incivility than those without such experience. A notable correlation also suggested that higher self-efficacy was associated with lower perceptions of incivility, indicating that students who feel confident in their ability to handle challenges are less likely to be affected by incivility. These findings highlight the importance of fostering self-efficacy in nursing students as a protective factor against incivility.

Abstract: Background: Rural populations experience healthcare disparities, including workforce shortages, geographic isolation, limited access to specialty services, and adverse social determinants of health. These challenges are particularly evident in South Dakota, where nearly half of the population resides in rural or frontier communities. Because of these unique challenges associated with rural life, preparing nurses to work in rural America is critical in preparing a workforce capable of meeting the unique healthcare needs of this population. Methods: This article describes how South Dakota State University College of Nursing, located within a rural land-grant institution, has developed and adapted educational programs, workforce initiatives, community partnerships, and re-search programs to address persistent rural health challenges across the state and region. The College of Nursing (CON) includes three campus locations: Brookings, Sioux Falls, and Rapid City and includes undergraduate and graduate nursing education. Nursing education is designed to allow students to blend their nursing education with South Dakota's unique rural environment. Results: The CON offers multiple pathways into the profession, including traditional and accelerated Bachelor of Science in Nursing (BSN) pro-grams, an online BSN option utilizing a train-in-place model, master's-level nursing education and administrator programs, Doctor of Nursing Practice (DNP) programs, and PhD education. Through strategic academic-practice partnerships and federally funded work-force initiatives, the college prepares nurses for rural practice across primary care, acute care, long-term care, and underserved settings. Additional initiatives support Native American student success, rural workforce recruitment and retention, oral health outreach, care coordination for children and youth with special healthcare needs, and research focused on workforce well-being, workplace violence, and healthcare access. Conclusions: A multi-site college of nursing can serve as a model for improving rural healthcare access, strengthening the nursing workforce, and addressing the complex and persistent health needs of rural and frontier populations. South Dakota State Universi-ty CON demonstrates how innovative educational delivery models, community partnerships, and targeted workforce initiatives can contribute to sustainable rural healthcare solutions.

Abstract: Background: Excessive sugar consumption is a major contributor to chronic diseases including obesity, type 2 diabetes, dental caries, and mental health disorders. International evidence highlights the need to integrate nutrition and lifestyle education into nursing curricula. In Albania, where non-communicable diseases are rising, nursing education and clinical practice must adapt to address these challenges. Aim: This scoping review aimed to map recent evidence on sugar consumption, health outcomes, and policy interventions, and to explore how these can be integrated into nursing education and practice in Albania. Methods: Following Joanna Briggs Institute methodology and PRISMA-ScR guidelines, six databases (PubMed, Embase, CINAHL, ERIC, Academic Search Premier, PsycINFO) were searched for studies published between January 2021 and June 2026. Inclusion criteria were peer-reviewed articles in English addressing sugar consumption, health outcomes, or policy frameworks relevant to nursing education. Data extraction was performed using a structured template and analyzed through inductive thematic analysis. Results: Three dimensions emerged: ● Contextual: System-level interventions such as taxation, labeling, and public health campaigns support healthier choices. ● Social: Cultural norms, family practices, and peer influences shape sugar consumption, requiring community-based interventions. ● Individual: Sugar intake is linked to chronic disease, dental health, and mental well-being, highlighting the need for counseling and behavioral support. Rising rates of obesity and diabetes at QSUT underscore the urgency of integrating these dimensions into nursing curricula. Conclusion: Sugar consumption poses a multidimensional challenge requiring contextual, social, and individual responses. Nursing education at University Aldent should incorporate policy literacy, community engagement, and counseling skills. Collaboration between QSUT, academic institutions, and public health authorities is essential to strengthen Albania’s response to sugar-related diseases.

Abstract: The aim of the present study is to analyse the relationship between sociodemographic variables and the perception of obstetric violence in Spain. A cross-sectional study was carried out through an online questionnaire. A descriptive analysis of all variables was performed followed by a bivariate analysis using the Chi-Squared test. Finally, all statisti-cally significant variables were included in a multivariate binary logistic regression mod-el. Data were processed and graphs created using Jamovi 2.3.28 software. Statistical sig-nificance was set at p< 0.05. A total of 6060 women were included in the study. Some 33.5% (n=1578) referred to having experienced obstetric violence or not being aware of it. Variables that showed a statistically significant relationship with obstetric violence were (p< 0.05): aged between 18 and 25 years, being a student, being of Romani ethnicity, being treated in public health, and labour being completed with urgent caesarean section or in-strumental delivery. The binary logistic regression model proved significant (X2=314; p< 0.001), with high sensitivity (0.970), an AUC=0.647 and a Nagelkerke pseudo-R2 deter-mination of 0.079. Young women face higher obstetric violence, influenced by occupation and ethnicity, reflecting socioeconomic and cultural care impacts. Improving obstetric practices is crucial for women's autonomy and respectful childbirth care.

Abstract: Background. Multiple sclerosis (MS) is a chronic neurological disease in which physical disability, psychological stress, impaired self-management, and reduced self-efficacy may interact over time. Peer education based on Pender’s Health Promotion Model (PHPM) has been investigated as a strategy for improving quality of life, stress management, and self-efficacy in patients with MS. Classical statistical analyses, however, normally represent observed outcomes by precise numerical summaries and consequently provide limited mathematical language for distinguishing measurement variability from genuine indeterminacy, incomplete information, or conflicting evidence. Objective. The objective of this paper is to develop a neutrosophic framework for representing and analysing clinical outcomes associated with peer education based on Pender’s Health Promotion Model. The framework is applied as a secondary mathematical interpretation of a previously published randomized controlled trial involving 90 patients with multiple sclerosis. Methods. A single-valued neutrosophic representation is developed in which each clinical outcome is characterized by a truth-membership component, an indeterminacy component, and a falsity-membership component. Neutrosophic representations are constructed for quality of life, stress management, and self-efficacy. We introduce neutrosophic change vectors, intervention-effect indices, an indeterminacy-adjusted health-promotion index, and sensitivity procedures. The published summary statistics are retained as the empirical basis; no individual patient-level observations are fabricated. Results. The published clinical study reported significant improvements in quality of life, stress management, and self-efficacy in the intervention group immediately after the educational intervention and at three-month follow-up, whereas corresponding changes in the control group were not statistically significant. The proposed neutrosophic framework preserves these observed directions while explicitly representing uncertainty surrounding the reported aggregate evidence. The resulting formulation makes it possible to distinguish a strong direction of observed change from the degree to which the available evidence remains indeterminate. Conclusions. Neutrosophic modelling provides a flexible mathematical language for clinical education research in which measurements may contain variability, incomplete information, contextual uncertainty, or heterogeneous patient responses. The framework should be regarded as a methodological extension and not as a replacement for conventional randomized-trial statistics. A definitive patient-level neutrosophic reanalysis requires access to the original individual-level dataset.

Abstract: Lean-oriented redesign is widely used to improve hospital flow and productivity, but the capabilities nurses need to implement and sustain change remain poorly defined. This critical narrative review integrates empirical evidence concerning nursing capability, organizational conditions, implementation, sustainment, and performance. Nursing-specific instruments assess perceived Lean implementation or service leanness, but none validates nursing improvement capability as an adaptive individual and collective capacity. The most credible candidate manifestations are practical knowledge and judgement, collective problem-solving, learning, professional agency, and enacted improvement leadership. Staffing, protected time, decision authority, data access, and infrastructure shape whether these capabilities can be expressed but are not equivalent measures of capability. Operational process improvements are reported most often, yet causal attribution is weak. Evidence for reallocated bedside time, net economic value, workforce benefit, patient safety, environmental benefit, and long-term sustainment remains limited or inconsistent. Evaluations should measure capability, context, implementation, sustainment, benefits, and harms separately and prospectively.

Abstract: Background/Objectives: Mobility is a key determinant of autonomy, participation, and quality of life among nursing home residents. Despite its importance, residents of long-term care facilities are often highly inactive and experience progressive mobility decline. Kinaesthetics is a movement-oriented nursing concept that aims to enhance residents’ own movement resources and participation in everyday care activities. However, robust evidence regarding its effectiveness in long-term care settings remains limited. This study investigated whether the implementation of a comprehensive kinaesthetics programme was associated with differences in mobility development among nursing home residents compared with usual care. Methods: A quasi-experimental longitudinal study was conducted in 12 long-term care facilities in southern Germany. Six facilities implemented a comprehensive kinaesthetics programme, while six facilities served as controls. Resident mobility was assessed using the EBoMo instrument, which measures independence in 11 mobility-related activities (range 11–44 points). Two paired samples were created for two observation periods (2019–2021 and 2021–2022). Changes in mobility status were analysed using group comparisons and multivariable linear regression models adjusted for baseline mobility, age, sex, and care level. Results: A total of 142 residents were included in the 2019–2021 analysis and 107 residents in the 2021–2022 analysis. Baseline characteristics were comparable between intervention and control groups. Between 2019 and 2021, mobility declined in both groups but less strongly in the intervention group (−2.02 vs. −4.39 EBoMo points). This difference showed borderline statistical significance in unadjusted analyses (p = 0.051) but was not significant after adjustment (p = 0.097). No significant group differences were observed between 2021 and 2022. In both regression models, baseline mobility was the strongest predictor of follow-up mobility status. Conclusions: The findings provide no clear evidence that the comprehensive kinaesthetics programme significantly improved residents’ mobility compared with usual care. Although a trend towards a smaller decline in mobility was observed during the first observation period, this effect was not confirmed in subsequent analyses. Further research with larger samples and additional outcome measures is needed to clarify the potential benefits of kinaesthetics-based care in long-term care settings.

Abstract: Introduction: Coordinating clinical education and training between nursing education institutions and clinical placement sites remains a persistent challenge, contributing to miscommunication, unfulfilled clinical hours, and inconsistent supervision. Mobile technology, and mobile applications specifically, have been proposed as a mechanism to strengthen this coordination. Objective: This manuscript describes the conceptual framework and the design-and-development process of a mobile application (WILApp) intended to coordinate the clinical education and training of undergraduate nursing students at a university in Gauteng, South Africa, and reports the practice-oriented theoretical structure and the nine-step technical development process that produced it. Methods: A design and developmental research (DDR) approach, situated within Phase 2 (the design/development phase) of a four-phase, convergent mixed-methods study, was used. Phase 1 qualitative and quantitative data, analysed respectively through thematic analysis and descriptive statistics and merged using a side-by-side comparison method, together with the literature review and theoretical framework, informed the requirements gathering, technology-stack selection, and user-interface design undertaken in partnership with an appointed information technology (IT) company under a signed non-disclosure and service-level agreement. Pseudonymised registration and role-based access control safeguarded participant data throughout the design and development process. Results: A conceptual framework based on Dickoff, James and Wiedenbach's survey list for practice-oriented theory was developed, specifying the agents, recipients, context, procedure, dynamics, and outcome of the mobile application. The resulting application, WILApp, was built using React Native with a Firebase backend and comprised screens for registration, login, clinical hours tracking, assessment, progress, and data report generation. Development followed nine sequential steps: requirements gathering; user interface and user experience design; technology stack selection; backend development; mobile application development; testing and quality assurance; documentation and release readiness; deployment and support; and maintenance and future enhancements. Conclusion: A theory-driven, iterative design-and-development process, grounded in integrated empirical findings and a practice-oriented conceptual framework, produced a functional, purpose-built mobile application capable of supporting the coordination of clinical education and training. This process offers a replicable model for developing similar digital tools in resource-constrained nursing education contexts.

Abstract: Background/Objectives: To analyze the concept of “care practices” as an abstract, relevant element of interest to the nursing discipline. Methods: The Walker &amp; Avant methodology was followed, a structured eight-stage process that ranges from the choice of the concept and the identification of its essential features to the creation of comparative examples (cases) and the definition of their practical effects. The analysis was based on the paradigm of simultaneity, a vision that breaks with the traditional biomedical model, to understand the human being as an indivisible unit. Recognizing the tension between the analytical-positivist roots of the method and the chosen paradigm, Walker &amp; Avant was used in an adaptive, heuristic way. Results: Based on the review of 12 predominantly qualitative articles, "care practices" are defined as actions aimed at solving needs in situations of vulnerability through an interpersonal bond influenced by the environment. Five defining dimensions were identified: awareness of vulnerability, activities in the intersubjective human bond, influence of the environment, recognition of intersectionality without judgment, and the prerequisite of care of the self. Conclusions: Concept analysis provides nursing with scientific rigor, allowing for the delimitation of its scope and grounding its practice. “Care practices” transcend a mere activity to become a profound human encounter based on the recognition of shared vulnerability, involving not only healthcare personnel but human beings in general.

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 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: Self-managed nursing teams 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 Self-managed nursing teams 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/Objectives: Work engagement, burnout, and self-care may be relevant to work functioning, but their mutually adjusted associations with in-role and extra-role job-performance scores remain insufficiently characterized. This study examined self-reported in-role and extra-role performance among nursing personnel in six public hospitals in Northern Greece. Methods: We conducted a secondary analysis of multicentre cross-sectional survey data collected during the COVID-19 pandemic for an MSc project. The dataset comprised 586 nurses and nurse assistants recruited by convenience sampling. Work engagement, burnout, self-care, and job performance were assessed using the UWES-9, OLBI, a study-developed 35-item Self-Care Index, and a six-item job-performance adaptation. Job-performance structure was evaluated using confirmatory factor analysis. Three linear regression models used a complete-case sample (n = 574), with HC3 and hospital fixed-effects sensitivity analyses. Results: A correlated two-factor job-performance model showed improved fit over a one-factor model, although factor overlap remained. Work engagement showed the largest standardized association with in-role (β = 0.285) and extra-role (β = 0.402) performance, as well as with the complementary total score (β = 0.376; all p < 0.001). Higher Self-Care Index scores also remained associated with in-role (β = 0.193, p < 0.001), extra-role (β = 0.100, p = 0.018), and total performance (β = 0.159, p < 0.001). Burnout did not retain a statistically detectable mutually adjusted association with any outcome. Conclusions: Work engagement was the most consistent correlate of self-reported performance, while higher Self-Care Index scores showed smaller positive associations. These cross-sectional, self-reported findings from a pandemic-era non-probability sample warrant prospective evaluation using independently assessed performance and organizational outcomes.

Abstract: Background/Objectives: The integration of Artificial Intelligence (AI) and Machine Learning (ML) in healthcare has shown promise for analyzing complex data and identifying patterns that can enhance clinical decision-making and patient care. Patient complaints represent a valuable yet underutilized data source for improving healthcare quality and patient safety. This study aimed to investigate whether an AI-driven model could effectively categorize patient complaints to extract actionable insights that support person-centered care and nursing practice to improve care quality. Method: An explorative study design was conducted as a pilot project. A total of 368 patient complaint reports collected by a Patients’ Advisory Committee were analyzed using AI-driven clustering and classification techniques. The complaints were pre-processed through text cleaning, tokenization, and vectorization before being analyzed with various clustering algorithms. Results: The AI-based classification identified four main areas that directly or indirectly influenced patients’ perceptions of care quality: (1) Care and Treatment, (2) Communication, (3) Administrative Management, and (4) Availability. These areas encompassed themes such as diagnostic delays, poor communication, fragmented administrative processes, and limited accessibility. The results highlighted that communication failures, insufficient empathy, and lack of continuity were central to patient dissatisfaction. Automated analysis enabled the identification of recurring issues and systemic weaknesses that traditional manual review methods often overlook. Conclusion: This pilot study demonstrates the feasibility and potential of using an AI-driven model to categorize patient complaints and identify patterns that may provide actionable insights for person-centered care and nursing practice to improve quality of care. The multilabel approach enabled an efficient and systematic analysis of complex complaints and may, following further validation, offer a scalable and consistent basis for understanding patient concerns. In nursing practice, integrating AI into patient feedback systems could support the earlier identification of recurring concerns and contribute to more responsive, evidence-informed, and person-centered quality improvement. However, larger datasets, independent expert validation, and careful consideration of ethical, legal, and governance requirements are needed before the model can be implemented more broadly.

Abstract: Objectives: To evaluate whether a multifaceted educational intervention was associated with changes in healthcare professionals’ knowledge, attitudes, self-reported practices, and catheter-associated urinary tract infection incidence in medical wards. Methods: This before-and-after intervention study was conducted in three internal medicine wards of a tertiary general hospital between September 2023 and December 2025, including a pre-intervention period (September 2023–April 2025), an intervention period (May–June 2025), and a post-intervention period (July–December 2025). The intervention included face-to-face education, interactive discussions, printed materials, posters, and ward-based reminders on evidence-based urinary catheter care. Healthcare professionals completed an anonymous structured questionnaire before and after the intervention, while catheter-associated urinary tract infection surveillance was conducted prospectively. Pre- and post-intervention questionnaire data were analyzed as independent groups. Results: We obtained questionnaire responses from 85 healthcare workers before the intervention and 78 after the intervention. The median total knowledge score increased significantly from 21 (interquartile range [IQR], 19–22) to 23 (IQR, 22–25; P < 0.001). Selected self-reported practices also improved significantly, whereas attitudes and perceptions were generally favorable at baseline and did not change significantly. The overall CAUTI rate decreased from 3.79 to 1.94 episodes per 1,000 catheter-days. After adjustment for ward, the post-intervention period was associated with a significantly lower CAUTI incidence (incidence rate ratio, 0.50; 95% confidence interval, 0.28–0.90; P = 0.020). Conclusion: The educational intervention was associated with improved knowledge, selected improvements in self-reported catheter-care practices, and lower catheter-associated urinary tract infection incidence.