Abstract: Background/Objectives: The assessment of clinical competencies in nursing education requires valid and reliable instruments, especially for essential procedures such as the placement of a cervical collar in the care of polytrauma patients. The objective of this study was to analyze the psychometric properties of a rubric designed to assess the placement of cervical collars in nursing students in a low-fidelity clinical simulation environment. Methods: A quasi-experimental, cross-sectional study was conducted with 186 undergraduate nursing students, organized into 62 groups, over three academic years (2021–2024). An 8-item rubric was applied, with a 4-level Likert scale (1–4). Interrater reliability was analyzed using Cohen’s Kappa index, internal consistency using Cronbach’s alpha, and the internal structure of the instrument using exploratory factor analysis, applying Varimax orthogonal rotation. Results: Inter-rater reliability showed values ranging from moderate to substantial, with greater agreement observed in items related to the selection of the collar and the position of the medical team, and moderate agreement in those related to technical maneuvers and immobilization. The rubric showed adequate overall internal consistency (α = 0.76), with good to very good consistency values in 6 of the 8 items. Exploratory factor analysis identified a two-dimensional structure with a dominant procedural factor (4 items) and a second factor associated with clinical judgment (4 items). Conclusions: The validated rubric has adequate levels of reliability and internal consistency for evaluating the placement of cervical collars by nursing students. Its application can promote more objective and structured evaluation processes in clinical simulation for nursing students, contributing to the development of essential skills in the care of polytrauma patients.

Abstract:

Background Rhinoplasty was the most frequently performed surgical procedure. Involuntary thoughts may occur before rhinoplasty, which can negatively affect both the psychological state and the postoperative healing process. Objectives This study was conducted to evaluate the effects of education provided to patients undergoing rhinoplasty on their preoperative intrusive thoughts and postoperative recovery. Methods This study was designed as a single-center, pretest-posttest, randomized controlled trial conducted in a state hospital between January 2024 and December 2024. The sample size was determined using power analysis, and 41 and 41 people were included in the control and intervention groups, respectively. Data were collected using the Personal Information Form, Preoperative Intrusive Thoughts Inventory (PITI), and Postoperative Recovery Index (PoRI). The intervention group received preoperative and discharge education via PowerPoint presentation and brochures. Results A significant decrease was detected in the preoperative PITI scores in the experimental group (p < .05). Although no statistically significant difference was observed between the total PoRI mean scores of the intervention and control groups before discharge after surgery, the total PoRI mean score of the patients in the intervention group on the seventh day after surgery was found to be statistically significantly lower than that of the patients in the control group (p < .05). Conclusion In conclusion, the education provided to patients who underwent rhinoplasty via PowerPoint presentation and brochure before surgery and before discharge reduced preoperative intrusive thoughts and positively affected postoperative recovery.

Abstract: Background/Objectives: Maternal mortality is a serious public health problem and reflects social, ethnic, racial, and regional inequalities in access to and quality of obstetric care. Despite advances in the surveillance and investigation of maternal deaths in Brazil, late maternal deaths (occurring between 43 days and 1 year after birth) are still underestimated and underexplored. Therefore, the objective of this study was to analyze the distribution and factors associated with maternal deaths and late maternal deaths in Brazil between 2010 and 2023. Methods: This was a population-based, retrospective cohort study with a quantitative approach, using secondary data from the Mortality Information System. All maternal deaths (Chapter XV of ICD-10) and late deaths recorded during the period were included. Sociodemographic, clinical, and administrative variables were analyzed. Statistical tests of association (chi-square, test of proportions, and 95% CI) were used, with a significance level of 5%. Results: A total of 26,953 deaths were identified, of which 24,387 were maternal and 2,566 were late deaths. Most deaths occurred among single, mixed-race women with 8 to 11 years of schooling, and residing in the Southeast region. Late deaths were more frequent in the South and among women aged 40 to 49. The main causes were direct obstetric conditions. A statistically significant association was observed between the type of death and sociodemographic variables. Conclusions: The results highlight structural inequalities in maternal mortality in Brazil and reinforce the importance of expanding postpartum surveillance beyond 42 days, with a focus on equity and continuity of care.

Abstract: Background: To describe the comparison between Black and White pregnant and postpartum women with COVID-19 regarding the need for hospitalization in the Intensive Care Unit, mechanical ventilation, and outcome to death. Methods: Integrative Literature Review conducted in Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica Database, Latin American and Caribbean Literature in Health Sciences, Medical Literature Analysis and Retrieval System Online via the National Library of Medicine, Science Direct from Elsevier Scientific Publications, SciVerse Scopus, and Web of Science. Results: Black pregnant and postpartum women presented worse clinical outcomes; the risk of death among these women was up to five times higher compared to White women, in addition to inequalities in timely access to intensive care. Conclusions: Black pregnant and postpartum women were disproportionately affected by COVID-19, with a higher risk of severe complications and death, which reinforces the need for care strategies that consider racial inequalities to reduce maternal mortality.

Abstract: Background/Objectives: Maternal mortality remains an important indicator of health inequities, reflecting social, regional, and racial inequalities, as well as the responsiveness of health systems. This study aimed to analyze and compare maternal mortality between Brazil and Portugal from 2020 to 2023. Methods: This is a binational ecological and observational study based on secondary data from official records of live births and maternal deaths in both countries. Maternal mortality rates were calculated per 100,000 live births and stratified by sociodemographic and regional variables. Poisson regression models offset by the logarithm of live births were used to estimate adjusted incidence ratios (IRR) and 95% confidence intervals. Analyses were conducted using R and Stata software. Results: Brazil presented rates between 55 and 62 per 100,000 live births, while Portugal maintained lower values, ranging from 8 to 20 per 100,000. In Brazil, higher risks were observed among Black and Indigenous women, residents of the North and Northeast regions, and in age groups above 30 years. Direct and indirect causes showed similar proportions, with an increase in indirect causes during the pandemic. In Portugal, mortality showed low magnitude, but annual fluctuation was attributed to the small number of events and the limitation of microdata. Conclusions: The study highlights strong structural and racial inequalities in Brazilian maternal mortality, contrasting with the lower magnitude and greater stability observed in Portugal. This reinforces the need for intersectoral actions, strengthening the obstetric network, and continuous surveillance to reduce preventable deaths and promote equity in maternal care.

Abstract: Background: Gender-based violence (GBV) represents a major public health issue with significant clinical, psychological, and legal implications. Healthcare professionals play a critical role in the detection, documentation, and medico-legal assessment of GBV cases, particularly in judicial contexts. Methods: A qualitative document analysis was conducted on Spanish Supreme Court judgments issued between 2023 and 2025 under Organic Law 10/2022. A thematic coding matrix was developed to identify interpretative patterns, criteria for evidentiary assessment, and the role of healthcare professionals. Data were analyzed using Atlas.ti, with triangulation against legal and healthcare literature. Results: The victim’s testimony was consistently established as the primary form of evidence when meeting criteria of persistence, coherence, and credibility. The gender-based aggravating factor was applied in a contextualized manner, requiring evidence of domination or discrimination. Sentence reviews reflected the principle of favorable retroactivity, although interpretative variability persisted. Healthcare professionals contributed as key evidentiary agents, particularly through clinical documentation and forensic reports, which reinforced testimonial credibility and supported the classification of habitual abuse. Conclusions: The findings highlight the increasing integration of healthcare-related evidence in judicial decision-making on GBV. Strengthening clinical documentation, interdisciplinary training, and medico-legal protocols is essential to improve both patient outcomes and judicial accuracy. A coordinated healthcare–legal approach is crucial to address GBV as a complex public health challenge.

Abstract: Background/Objectives: Severe brain injuries generate complex, long-term needs requiring intensive physical, cognitive and relational care. These conditions also profoundly affect families, who often experience emotional distress, uncertainty and a heavy caregiving burden. Although neuro-palliative care is increasingly recognised, the early integration of palliative care for this population remains limited. This study aimed to explore healthcare professionals’ perceptions of the palliative care needs of patients with severe brain injuries and their caregivers, and to identify factors that hinder or facilitate early palliative care implementation in specialised settings. Methods: An interpretive qualitative study was conducted using Reflexive Thematic Analysis. Fifteen semi-structured narrative interviews were carried out with healthcare professionals working in specialised hospital units in Northern Italy. Data were analysed inductively through an iterative and reflexive process following Braun and Clarke’s six phases. Methodological rigour and transparency were ensured using the COREQ checklist. Results: Five themes were identified: (1) intensive, individualized patientcare needs with complex communication issues; (2) palliative needs centred on dignity, quality of life and early integrated management; (3) caregivers’ involvement and expectation related difficulties; (4) continuous or anticipatory grief requiring structured psychological support; (5) facilitators and barriers influencing care pathways. Conclusions: Healthcare professionals identify intertwined and evolving palliative care needs in both patients with severe brain injuries and their families. Findings underscore the importance of early, integrated and multidisciplinary neuro-palliative care models focused on dignity, symptom relief and sustained emotional support.

Abstract: Background Basic life support (BLS) competency is essential for nurses, who are often the first healthcare professionals to recognize and respond to cardiac arrest in hospital settings. Maintaining up-to-date resuscitation knowledge and skills through continuing education is critical for improving patient outcomes. Method This prospective educational intervention study evaluated the impact of a standardized BLS training program on nurses’ knowledge and cardiopulmonary resuscitation (CPR) performance. A total of 321 nurses participated in a 45-minute training session based on European Resuscitation Council guidelines. Knowledge was assessed using a 10-item questionnaire administered before and after training. CPR performance was evaluated using a simulation-based cardiac arrest scenario and a structured 10-item checklist. Results Post-training knowledge scores increased significantly (2.9 ± 1.6 vs 4.2 ± 1.1, p < 0.001; Cohen’s d = 0.97). Successful CPR performance was observed in 81.3% of participants. Higher post-training knowledge scores were independently associated with CPR success (OR = 1.56, 95% CI: 1.13–2.16, p = 0.007). Knowledge scores demonstrated modest predictive ability for CPR success (AUC = 0.62). Conclusion Integrating structured BLS training with simulation-based assessment may strengthen nurses’ preparedness for cardiac arrest situations. Integrating simulation-based resuscitation training into continuing nursing education programs may strengthen nurses’ preparedness for cardiac arrest situations.

Abstract:

Background: Nursing professionals must fulfill their care duties within a system that requires 24-hour coverage. This necessitates hospitals implementing a shift-work system to meet care demands. Purpose: To assess sleep quality and its relationship with interconnected health variables among nursing professionals working shifts. Method: A cross-sectional descriptive observational study. 247 nursing professionals, 85.8% of whom were women, aged between 21 and 65, from Son Espases University Hospital in Spain. A corporate email was sent containing a link to an online: the Pittsburgh Sleep Quality Index (PSQI), Munich Chronotype Questionnaire (MCTQ) to determine chronotype, the Perceived Stress Scale (PSS-14), General Health Questionnaire (GHQ-12), Memory Failures of Everyday Life Questionnaire (MFE-30), and the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF), applied across different work shifts. Results: Nurses, regardless of shift work, reported poor sleep quality (score > 5), a higher proportion of undefined chronotype (60%), moderate levels of perceived stress (26 points), a tendency toward poorer general mental health (14 points), and more memory complaints (60 points), but a favorable perception of their quality of life (90 points), with no statistically significant differences found. Female professionals working rotating shifts showed significant differences, presenting a higher number of memory complaints compared with males. Professionals over the age of 50 working night shifts displayed significantly poorer general mental health and severe memory complaints. Conclusion/Implications for Practice: Nursing professionals show poor sleep quality, elevated stress levels, signs of emotional disorders, and moderate memory complaints, particularly on night and rotating shifts, which were observed, albeit without significantly affecting perceived quality of life. These findings support the need to implement organizational strategies that safeguard the well-being of nursing professionals and to consider individual patterns to improve sleep health.

Abstract: Background/Objectives: Needle-related procedures such as venous catheter access are common in pediatric hospitals and are a major cause of pain, stress and anxiety for those affected. Nowadays, a wide range of evidence-based support options are available, but it is often the professionals who decide which interventions are offered. In this study, we adapted the CARD^TM (Comfort, Ask, Relax, Distract) system for needle-related proce-dures in hospitals. CARD^TM was originally developed to encourage children to actively participate in their vaccination process at school. It allows them to choose from numerous evidence-based interventions in the four different letter categories (C-A-R-D) to reduce pain, anxiety and related vaccination symptoms. Our aim was to examine the experiences of using CARD^TM during needle-related procedures in a children's hospital. Methods: A qualitative descriptive design was used. The sample included nine children aged 10 to 15 undergoing needle-related procedures and seven nurses who performed these procedures. We conducted individual interviews and asked them about their experiences with CARD^TM. Data were evaluated using qualitative content analysis. Results: Four themes were identified: Awareness of options and needs; relationship building; empowerment; and acceptability. CARD^TM was helpful for children in identifying available options, pre-paring themselves, recognising their own needs and developing strategies. CARD^TM of-fered a concrete framework for action that promotes participation and self-efficacy and strengthens the relationship between nurses and children. In practice, CARDTM proved to be easy to implement and highly accepted. Conclusion: The present findings largely confirm previously published research results on CARD^TM in the school vaccination setting.

Abstract: This study aimed to evaluate the effectiveness of counseling and educational interventions delivered during pregnancy and early motherhood in promoting maternal health knowledge, self-care behaviors, and related health outcomes among adolescent and young women. A systematic review of randomized controlled trials and quasi-experimental studies published in English or Spanish was conducted using Medline, Web of Science, Scopus, Cinahl, and the Cochrane Library. Methodological quality was assessed using Joanna Briggs Institute critical appraisal tools, and risk of bias was evaluated using the Risk-of-Bias 2 and ROBINS-I tools. Data were synthesized narratively and in tables. When comparable outcomes were reported, preliminary meta-analyses were performed using standardized mean differences with random-effects models. The certainty of evidence was assessed using the GRADE approach. Seven studies (n = 7) involving 776 participants were included. Interventions consisted of counseling or educational programs delivered through face-to-face sessions, group activities, or digital resources. Overall, the interventions showed improvements in pregnancy-related knowledge, self-care behaviors, psychological outcomes, and maternal health practices and attitudes. Meta-analysis suggested a large effect favoring the intervention for pregnancy-related health knowledge (SMD = 1.90; 95%CI: −0.02 to 3.83) and self-care behaviors (SMD = 2.39; 95%CI: 0.29–4.49), although substantial heterogeneity across studies was observed and the certainty of evidence ranged from low to very low. Counseling and educational interventions during pregnancy may improve pregnancy-related health knowledge and self-care among pregnant adolescents and young women. Nevertheless, the evidence remains limited and heterogeneous. Further well-designed studies conducted in diverse settings are needed to confirm these findings and strengthen the evidence base.

Abstract: To explore the internal path through which smart elderly care technology influences older adults' sense of self-control and social connectedness, and to provide empirical evidence and theoretical support for optimizing the smart elderly care service system and enhancing older adults' psychological well-being, this study integrated the Empowerment Theory and the Technology Acceptance Model (TAM). A cluster sampling method was adopted to conduct a questionnaire survey among 1,031 older adults in communities in Jiangsu, Shandong and other provinces in China. A structural equation model was constructed, and Bootstrap method, multi-group analysis and other approaches were used to test the research hypotheses. The results showed that the use of smart elderly care technology significantly and positively improved older adults' sense of self-control through the empowerment effect (β=0.382, p< 0.01) and technology acceptance (β=0.415, p< 0.01), and significantly enhanced their social connectedness through the construction of social support networks (β=0.363, p< 0.01). Empowerment played a partial mediating role between the use of smart elderly care technology and sense of self-control, with the mediating effect accounting for 38.2%. Technology acceptance exerted a partial mediating effect between the use of smart elderly care technology and social connectedness, with the mediating effect accounting for 40.1%. Technology acceptance also played a partial mediating role between empowerment and sense of self-control, and there was a significant interaction effect between empowerment and technology acceptance, which jointly and positively affected older adults' sense of self-control (β=0.103, p< 0.05) and social connectedness (β=0.087, p< 0.05). This study verified the chain mechanism of "technological empowerment - psychological acceptance - social integration" of smart elderly care technology. It is suggested to construct an optimized path for smart elderly care services with the core concepts of "digital inclusion" and "relational empowerment", and promote the in-depth integration of technological empowerment, humanistic care and traditional Chinese medicine health management.

Abstract: Background: Emergency obstetric situations require rapid clinical decision-making, technical competence, and emotional preparedness to ensure safe and compassionate care for both mother and newborn. However, nursing students often have limited opportunities to experience such high-risk, low-frequency events during clinical placements. Simulation-based education has emerged as an effective strategy to prepare future nurses for caring in emergency contexts, allowing them to develop both technical and non-technical skills in a safe learning environment. This study aimed to evaluate the impact of a high-fidelity obstetric emergency simulation program on nursing students’ knowledge, perceived safety, and learning experience. Methods: A mixed-methods design was employed, combining a quasi-experimental pretest–posttest assessment without a control group and qualitative analysis of open-ended reflections. Eighty-two third-year nursing students participated in two simulation sessions addressing obstetric emergencies such as breech birth, shoulder dystocia, out-of-hospital delivery, eclampsia, postpartum hemorrhage, and maternal cardiac arrest. Data were collected using validated instruments measuring knowledge, perceived safety, and satisfaction and self-confidence in learning, and were analyzed using Wilcoxon signed-rank tests and thematic analysis. Results: Significant improvements were observed in students’ knowledge of complex obstetric maneuvers and in their perceived safety when managing emergency situations (p &lt; .001, r &gt; .40). Participants reported high levels of satisfaction and confidence in learning. Qualitative findings highlighted increased emotional preparedness, improved clinical reasoning, and recognition of the importance of teamwork and reflective debriefing in emergency care contexts. Conclusions: High-fidelity simulation is an effective educational strategy for preparing nursing students to provide safe and confident care in obstetric emergencies. Integrating simulation into nursing curricula can strengthen both technical competence and the emotional readiness required for caring in urgent and high-pressure clinical situations.

Abstract: Background: This study aims to psychometrically validate the abbreviated version of the Connor-Davidson Resilience Scale (CD-RISC-10) in Peruvian nurses, evaluating its convergent validity through its association with perceived stress and empathy. Methods: A cross-sectional psychometric study was conducted in 374 Peruvian nurses to evaluate the psychometric properties of CD-RISC-10 through confirmatory factor analysis (CFA). In addition, convergent validity was examined by correlational analysis with Spearman's ρ coefficient with empathy and resilience. Results: The CFA confirmed that the one-dimensional model has a good fit (CFI = 0.978, TLI = 0.971, RMSEA = 0.080, and SRMR = 0.044). Cronbach's alpha of 0.89 and McDonald's omega of 0.81 were obtained. Convergent validity showed significant correlations with perceived stress (ρ = -0.23, p < 0.001) and empathy (ρ = 0.31, p < 0.001). Conclusion: The CD-RISC-10 has excellent psychometric properties in Peruvian nurses. Future studies are needed to evaluate their factorial invariance between clinical specialties and determine cut-off points.

Abstract: Background: Spirituality and religious diversity are increasingly recognized as essen-tial components of holistic nursing care in global healthcare systems. However, their integration into undergraduate nursing education remains heterogeneous and often insufficiently structured, creating a gap between professional values and students’ preparedness to address spiritual needs in culturally diverse clinical environments. This study aimed to explore nursing students’ perceptions, attitudes, and perceived skills regarding spirituality, religion, and spiritual care, and the factors associated with these dimensions. Methods: A descriptive exploratory survey was conducted on a sample of 69 third-year students of the Degree Course in Nursing belonging to two Roman universities. Data were collected between May and July 2025 using the Nursing Care and Religious Diversity Scale (NCRDS), consisting of 31 items. Statistical analyses included descriptive statistics, internal reliability analyses, group comparisons, and multivariate regression models. Results: Students showed moderate levels of attention to patients' spiritual needs and integration of spirituality into care practice, while high importance was given to spiritual care skills. University education was perceived as only partially adequate. Multivariate analyses showed that students' personal spiritu-ality is positively associated with the assessment of spiritual needs and the perception of competence, while exposure to contexts characterized by greater religious diversity is associated with a lower perception of preparedness. Conclusions: The results high-light a discrepancy between professional values and perceived operational skills, sug-gesting the need to systematically integrate spirituality and religious diversity into nursing curricula. A structured training approach could strengthen transferable pro-fessional skills and promote truly holistic and person-centred care.

Abstract: Background/Objectives: Patient safety culture represents a holistic approach to ensuring the safety of patient care. When nurses experience abusive behaviors, patient safety culture is undermined. Methods: A cross-sectional study was conducted in Greece, and data were collected via an online survey between October and December 2025. Workplace gaslighting and patient safety culture were measured using the Gaslighting at Work Scale and the Safety Organizing Scale, respectively. Multivariable linear regression analyses were performed using IBM SPSS Statistics 28.0. The level of statistical significance was set at 0.05. Results: The sample included 448 nurses. Almost nine out of ten of the participants (87.3%) were women, with an average age of 38.04 years (SD = 10.27). Regarding educational level, 42.2% held a MSc or PhD degree. Respondents reported moderate perceived workplace gaslighting with a mean score of 2.37 (SD = 1.04) on the Gaslighting at Work Scale. For safety culture, the Safety Organizing Scale yielded a mean score of 5.00 (SD = 0.91). In the univariable analysis, workplace gaslighting was significantly and negatively associated with safety culture (beta = -0.195, 95% CI = -0.275 to -0.115, p < .001), indicating that higher levels of workplace gaslighting were related to worse safety culture behaviors. This association was still significant even when potential confounding variables were considered (adjusted beta = -0.223, 95% CI = -0.305 to -0.142, p < 0.001). Conclusions: This study highlighted the negative impact of workplace gaslighting on patient safety culture. Healthcare organizational leadership is urged to establish and enforce zero-tolerance policies toward gaslighting behaviors and to foster an environment in which nurses are encouraged to speak up openly and report such behaviors.

Abstract: Background/Objectives: Limited research exists on the correlates of lifestyle habits among nursing students, particularly regarding their engagement with the Health-Promoting Lifestyle Profile-II, a widely used instrument. Bridging this gap is essential to advance nursing education and practice both at national and international levels. The objectives of this study were to assess health-promoting lifestyle behaviors, examine their relationships, and identify the correlates of positive health behaviors among nursing students. Methods: A cross-sectional study was conducted among 476 students in Spain. Collected data included sociodemographic–academic and health-related variables, along with Health-Promoting Lifestyle Profile-II scale. Correlation and hierarchical multivariate logistic regression analyses were performed. Results: The participants reported modest health-promoting behaviors (2.62±0.33), especially in health responsibility (2.20±0.48) and stress management (2.33±0.44). Health-related variables were more strongly associated with positive behaviors than sociodemographic–academic variables (p&lt;0.001). Significant correlates included Mediterranean diet adherence (high vs. medium and low adherence: AOR = 0.30 [95%CI=0.19–0.49]; p&lt;0.001 and AOR = 0.06 [95%CI=0.02–0.20]; p&lt;0.001), physical activity (high vs. moderate and low level: AOR = 0.52 [95%CI=0.32–0.85]; p=0.008 and AOR = 0.37 [95%CI=0.17–0.80]; p=0.012), and working status (employed vs. unemployed: AOR = 0.56 [95%CI=0.32–0.98]; p=0.042). Conclusions: Strengthening nursing curricula and training environments is essential to promote healthy behaviors. Empowering students can improve self-care, enhance their role as health educators, and support the sustainability of the nursing profession.

Abstract: Background/Objectives: The aim is to assess public stigma related to people with mental health problems and to observe the influence of sociodemographic factors on it. Methods: This observational, descriptive, and cross-sectional study was conducted with a sample of 404 participants who completed a self-administered online questionnaire that included sociodemographic variables and the Community Attitudes towards Mental Illness Scale (CAMI-S, Spanish version). Non-parametric tests, multiple linear regression, and statistical power analyses were applied. Results: The mean CAMI-S total score was 84.89 (SD = 11.122), indicating a generally positive attitude towards community integration. Statistically significant associations (p-value ≤ 0.05) were found between CAMI-S scores and variables such as gender, age, place of residence, educational level, mental health disorder, and close contact with someone with mental health disorders. The regression model revealed four significant predictors of lower stigma: identifying as female (β = 2.523; p = 0.037), having a medium or higher educational level (β = 5.061; p = 0.002), experiencing a mental health diagnosis (β = 4.535; p = 0.014), and a close contact (β = 4.183; p &lt; 0.001). Conclusions: These findings underscore the need for targeted anti-stigma strategies and reinforce the role of nursing in promoting mental health inclusion.

Abstract: Background/Objective: Nurses play a central role in operationalizing integration through coordination, screening, nursing care processes, community empowerment, and reporting. This study to examine the empirical distribution of an Implementation Fidelity Index (IFI) for nurse-led integrated primary care in Indonesia, grounded in five core domains: planning and coordination, early detection, nursing care processes, community education and empowerment, and reporting. Methods: We conducted a cross-sectional, facility-based online survey in 2025 among registered nurses working in Indonesian primary health care facilities (Puskesmas) and involved in integrated primary care activities. Implementation was measured using a structured 28-item questionnaire across five domains: planning/coordination, early detection, nursing care processes, community education/empowerment, and reporting (Likert 1–5). Domain scores were calculated as the mean of items within each domain; the overall Implementation IFI was calculated as the mean across all items and as the summed total score (range 28–140). We summarized domain and overall distributions (mean, SD, range) and examined inter-domain associations using Spearman correlations. Results: A total of 252 nurses completed the survey with no missing item responses. Overall IFI (item-mean) was 3.99 (SD 0.92; range 1.04–5.00), corresponding to a total score mean of 111.84 (SD 25.90; range 29–140). Domain means were highest for nursing care processes (4.28, SD 0.91) and early detection (4.09, SD 0.94), and lowest for community education/empowerment (3.75, SD 1.10). Using mean ±1 SD thresholds, 12.3% of nurses were categorized as low implementers, 71.8% moderate, and 15.9% high, indicating substantial heterogeneity. Inter-domain correlations were consistently positive and moderate-to-strong (ρ≈0.54–0.80; p&lt;0.001). Conclusions: Nurse-led integrated primary care implementation in Indonesia was moderate-to-high overall but uneven across nurses and domains, with comparatively weaker performance in community empowerment and reporting.

Abstract: Introduction: Climate change is increasingly affecting the health of older people. This study aimed to determine the knowledge, skills, and attitudes of nurses and undergraduate nursing students regarding the effects of climate change on older people’s health. Material and Methods: A descriptive cross-sectional study was conducted between January and April 2024 with 708 participants (210 nurses and 498 undergraduate nursing students). The Nursing Competencies Questionnaire on Environmental Health of Older People (NCQ-OPEH) was used to assess environmental competencies. Descriptive values were calculated and interrelationships between knowledge, attitudes, and skills were analysed. Results: A total of 115 nurses (54.75%) and 185 students (37.15%) demonstrated good-excellent knowledge. Similarly, a higher percentage of nurses (50.77%) reported better perceived skills than students (42.52%). However, the majority of both samples (98.97% and 87.85%, respectively) had good to excellent attitudes. These differences were significant for knowledge (p< .001) and attitudes (p= .013), but not for skills (p= .054). Furthermore, a significant relationship was found between prior education on climate change and health and greater knowledge (p= .019) and skills (p= .027) among nurses and better skills and attitudes (p< .001 in both) among nursing students. Conclusion: Nurses have better environmental competencies than undergraduate nursing students. Therefore, it is important to include education on climate change and older people's health to be included in the academic curriculum of university nursing degrees. Nurses also need to reinforce these competencies through specific educational programmes. This new tool will evaluate educational and formation sessions on climate change and the health of older adults.