This study aimed to evaluate the effects of an integrated nursing model on systemic inflammation, oxygenation, and clinical outcomes in children with severe respiratory failure. Children with severe respiratory failure requiring invasive mechanical ventilation for ≥72 hours were consecutively enrolled. Participants were allocated according to admission period into a routine nursing group (2023) and an integrated nursing group (2024-2025). The integrated nursing model involved multidisciplinary assessment, coordinated care planning, and continuous nursing evaluation. Primary outcomes included changes in inflammatory markers (interleukin-6, tumor necrosis factor alpha, and C-reactive protein), while secondary outcomes included oxygenation indices (PaO2/FiO2), duration of mechanical ventilation, pediatric intensive care unit length of stay, and complications. Data were analyzed using independent-sample tests, chi-square tests, and linear mixed-effects models. Compared with routine nursing, integrated nursing was associated with greater reductions in interleukin-6, tumor necrosis factor alpha, and C-reactive protein over time and faster improvements in oxygenation indices. The integrated care group also had shorter mechanical ventilation duration and pediatric intensive care unit length of stay, and a lower incidence of ventilator-associated pneumonia. Integrated nursing may improve inflammatory control, oxygenation, and clinical outcomes in critically ill children with severe respiratory failure. Further multicenter randomized studies are warranted.
This study aimed to adapt and evaluate the validity and reliability of the Pediatric-Friendly Care Assessment Scale in the Emergency Department, which assesses nurses' perceptions of the importance of pediatric-friendly care. This methodological study was conducted with 301 nurses working in pediatric emergency departments. Linguistic adaptation was performed using forward-backward translation, and content validity was evaluated using the Davis technique. Construct validity was assessed through confirmatory factor analysis (CFA). Reliability was examined using Cronbach's alpha, split-half method, and Spearman-Brown and Guttman coefficients. Additionally, item-total correlations and known-group comparisons were conducted. The mean age of the participants was 39.35 ± 5.80 years, and 82.1% were female. The scale-level content validity index was found to be 0.98 based on expert evaluations. CFA results showed that the model fit was acceptable (CMIN/DF = 2.485, RMSEA = 0.070, CFI = 0.88, IFI = 0.88, GFI = 0.83, NFI = 0.82, TLI = 0.86). The Cronbach's alpha coefficient of the total scale was 0.93, and the alpha values for the sub-dimensions ranged from 0.60 to 0.84. Item-total scale score correlations were between 0.25 and 0.79. The findings indicate that the Turkish form of the scale is a valid and reliable tool for evaluating nurses' perceptions of the importance of pediatric-friendly care in pediatric emergency departments. Implications for practice The scale can be used to evaluate pediatric-friendly care practices in pediatric emergency departments and to guide training and quality improvement initiatives in this field.
Predictors of suicidal behavior in adolescents who identify as LGBTQ+ include prior Emergency Department (ED) visits and hospitalizations. These youth report lack of psychological safety. Nursing staff need culturally congruent care proficiency to help LGBTQ+ youth seeking health care feel psychologically safe. The purpose of this study is to increase nursing staff knowledge, skills, and sensitivity to LGBTQ+ youth care. Nursing staff from a pediatric hospital in an urban setting participated in an evidence-based intervention study designed to increase congruent nursing care. This study adhered to the Strengthening Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines. Participants completed the Ally Identity Measure and an open-ended query pre-intervention (T1), 30 days (T2), and 90 days (T3) after the intervention. We found a significant increase in the knowledge and skills mean score between T1 and T2 (p < 0.001, n = 25), and between T1 and T3 (p < 0.001, n = 19). This research could improve equitable culturally congruent care delivery in the hospital setting. The evidence-based intervention curriculum used in this study was developed from the lived experiences of LGBTQ+ youth who needed emergency care for suicidality when they were adolescents. By constructing the curriculum using the voices of those most affected, this approach reflects a community-informed model of nursing practice which has the potential to meaningfully improve how patients experience care.
Parents of children with chronic diseases in rural Iran experience profound challenges, including limited access to pediatric specialists, social isolation, and severe financial strain. Concurrently, healthcare providers face workforce shortages, administrative burdens, and fragmented referral systems. This study aimed to explore unmet care needs and comparative perspectives of parents and providers regarding the integration of artificial intelligence to strengthen chronic disease management in resource-limited rural settings. Using a qualitative descriptive design, we conducted semi-structured interviews with 20 parents of children with chronic illnesses and 15 healthcare providers (physicians, nurses, and community health workers) from rural health centres in Iran. Participants were selected through purposive sampling based on direct experience with pediatric chronic disease management in villages (< 20,000 population). Data were analysed using conventional content analysis with iterative coding to derive emergent themes. Five key themes emerged: (1) Unmet daily care needs including geographic barriers to specialists, maternal emotional isolation, and catastrophic out-of-pocket expenses; (2) Systemic constraints faced by providers, notably administrative overload ("pajama time"), critical workforce shortages, and inefficient referral pathways; (3) AI as a potential bridge through symptom prediction models for early intervention, chatbots for emergency guidance, and AI-enabled teleconsultations to reduce unnecessary travel; (4) Divergent trust narratives parents expressed skepticism about autonomous AI decision-making while providers raised concerns about data privacy, workload implications, and erosion of clinical authority; and (5) Integration pathways emphasising AI embedded within the existing Behvarz (community health worker) network, mandatory digital literacy training, and co-designed platforms incorporating local cultural beliefs. AI technologies show promise for augmenting, though not replacing, human-centred care in rural pediatric chronic disease management. Successful implementation requires culturally resonant, transparent tools developed through participatory design with families and providers, robust data governance, and strategic alignment with Iran's primary healthcare infrastructure. This context-sensitive framework prioritises equity, trust-building, and caregiver empowerment while acknowledging the irreplaceable role of human empathy in chronic care delivery. Parents of children with chronic illnesses and healthcare providers were central to this research as knowledge partners rather than passive subjects. Twenty parents with lived experience of caring for a child with chronic disease in rural settings, alongside 15 frontline healthcare providers, actively shaped the study through in-depth sharing of their experiences during semi-structured interviews. Their narratives directly informed all emergent themes and the resulting conceptual framework. To ensure interpretive validity, we conducted member checking with a purposive subset of participants (n = 8 parents and n = 6 providers) who reviewed preliminary findings and provided feedback on whether the themes accurately reflected their realities and concerns. This iterative validation process strengthened the trustworthiness of our analysis and ensured that the final framework resonated with the everyday challenges and aspirations of rural families and providers. While participants were not involved in the initial study design or manuscript drafting due to the exploratory nature of this qualitative investigation, their experiential expertise fundamentally shaped the research outcomes and recommendations for culturally grounded AI integration. Their contributions transformed abstract technological possibilities into contextually meaningful pathways for supporting rural pediatric chronic disease management.
To explore nurses' perspectives regarding children's spiritual care in pediatric healthcare settings. Spiritual care is a fundamental source of comfort and healing and an essential. component of nursing practice. However, pediatric nurses often lack the competence and confidence to incorporate spiritual care into their clinical routines. Despite its importance, the perceptions and practices of pediatric nurses across various clinical specialties regarding spiritual care remain underexplored in current literature. The integrative review methodology was chosen to provide a comprehensive and up-to-date synthesis of the literature. Four electronic databases (CINAHL, MEDLINE, Scopus and Google Scholar) were used to search for relevant manuscripts. These studies were critically appraised by the three nursing academics using the Mixed Methods Appraisal Tool, Version 2018. Themes were subsequently generated following Braun and Clarke's (2022) thematic analysis framework. Eight manuscripts were selected. Thematic analysis generated three themes: spiritual care practices, barriers to spiritual care and nurses' inner spirituality. Providing spiritual care is a fundamental element of holistic care. Nurses achieve this by respecting family values, culture, rituals, traditions and facilitating opportunities for spiritual expression, however many nurses experience a sense of incompetence in delivering spiritual care. Barriers such as heavy workloads and insufficient formal education impair the effective delivery of spiritual care. Healthcare organisations should provide structured training and clear guidelines to help nurses deliver culturally sensitive and age-appropriate spiritual care. Supporting nurses' spiritual well-being also requires a committed, system-wide approach to foster resilience and a supportive work environment.
Thirst is one of the most distressing symptoms experienced by pediatric patients after surgery. This study aimed to explore and document the experiences of children, parents, and health professionals regarding postoperative thirst, providing insights to develop care strategies that address the emotional and psychological needs of pediatric patients. A qualitative approach was employed to gather in-depth insights into the experiences of children, parents, and health professionals regarding postoperative thirst. Purposive sampling was employed in a Pediatric Surgery Unit, involving a total of 40 participants: ten children, sixteen parents, and fourteen health professionals. Semi-structured interviews were conducted with all participants, and the transcribed data were analyzed using qualitative content analysis. The content analysis revealed five themes: physical symptoms, feeling of discomfort, lack of knowledge, coping strategies, and suggestions. This qualitative study highlights the critical importance of addressing postoperative thirst in enhance the physical and emotional well-being of pediatric patients, emphasizing that thirst is not merely a physical symptom but a multidimensional experience that significantly affects children and their families. This findings supports health professional should be educated on recognizing and managing postoperative thirst as a symptom in postoperative care. Integrating evidence-based thirst management strategies into postoperative care protocols can significantly improve patient outcomes, reduce anxiety, and promote recovery, ultimately advancing the quality of pediatric surgical care.
Although large language models (LLMs) show potential for patient education, their accuracy, usability, and comprehensibility lack validation in high-risk pediatric anesthesia. Rigorous evaluation is therefore essential prior to widespread clinical use in perioperative parental anesthesia education. This study aims to evaluate the accuracy, reliability, and readability of responses generated by 5 LLMs to parental inquiries regarding pediatric anesthesia, and to assess their suitability for clinical use in perioperative caregiver education. Two expert anesthesiologists identified 33 parental questions on pediatric anesthesia by screening authoritative resources and Google Trends. On December 14, 2025, these questions were submitted to 5 LLMs (DeepSeek-V3.2, ChatGPT-5, Gemini 2.5 Flash, Copilot, and Perplexity) via official web interfaces with default settings and zero-shot prompting, with each query in a separate conversation. Responses were standardized for blinded assessment. Two pediatric anesthesiologists with ≥10 years of clinical experience independently evaluated accuracy and reliability using the 4-point Likert accuracy scale, DISCERN, Ensuring Quality Information for Patients (EQIP), Journal of the American Medical Association (JAMA) benchmark, and Global Quality Score (GQS). After text preprocessing, readability was evaluated using 6 algorithms (Automated Readability Index [ARI], Flesch Reading Ease Score [FRES], Gunning Fog Index [GFI], Flesch-Kincaid Grade Level [FKGL], Coleman-Liau Index [CL], and the Simple Measure of Gobbledygook [SMOG]) via an online calculator. Interrater reliability was analyzed using the intraclass correlation coefficient (ICC); differences across models were assessed with the Kruskal-Wallis H test; and deviations from the sixth-grade benchmark were evaluated using 1-sample Wilcoxon signed-rank tests (P<.05 considered significant). All 5 LLMs demonstrated high clinical accuracy (>90%; P=.12), with Gemini reaching 100%. Nevertheless, safety risks and content hallucinations were still observed. Excluding Gemini and Copilot, the remaining 3 models (ChatGPT, DeepSeek, and Perplexity) each produced unsafe content in 3.03% (n=1) of the 33 queries. Hallucinations were detected in all models except Gemini, with DeepSeek and Perplexity showing the highest hallucination rate (3/33, 9.09%). Furthermore, Perplexity showed superior reliability on DISCERN (median 41; P<.05), yet no model achieved a "good" rating. Gemini achieved the highest EQIP (median 66.67%; P<.05) despite lower GQS (median 3). Transparency was universally poor (JAMA median ≤1), with DeepSeek and ChatGPT showing a "floor effect." ChatGPT had superior readability, but all models exceeded the recommended 6-grade complexity level. In this study, 5 LLMs generally provided clinically accurate information when responding to parental questions about pediatric anesthesia. However, limitations were also identified, including hallucinated content, safety-related deficiencies, limited source transparency, and readability levels exceeding recommended standards. Therefore, LLM-generated information should be interpreted with caution and should not replace clinician guidance.
This study aimed to investigate the mediating role of perceived stress (PS) in the relationship between organizational silence (OS) and occupational burnout (OB) among pediatric nurses professionals. A multicenter, cross-sectional study was conducted using a non-probability sampling design that combined convenience and snowball sampling strategies. From January 2025 to March 2025, nurses were recruited from the pediatric departments of three tertiary hospitals in China. Participants completed self-report questionnaires measuring OS, PS, and OB. Data were analyzed using correlation analyses and mediation analysis with bootstrap confidence intervals (CI) to test the hypothesized pathways. The findings indicated notable positive associations between the three variables. OS showed a positive correlation with both PS (β = 0.40, P < .001) and OB (β = 0.36, P < .001). PS was also positively correlated with OB (β = 0.42, P < .001). PS was significantly influenced by OS and, in turn, was a significant predictor of OB. The indirect effect of OS on OB through PS was significant (β = 0.17, 95% CI: 0.09-0.24), accounting for 32.26% of the total effect. OS is significantly associated with OB among pediatric nurses, and this relationship is partially mediated by PS. Interventions aimed at reducing OS and managing PS may be effective in mitigating burnout in pediatric nurses professionals. Nursing administrators should establish anonymous feedback channels and structured dialogue sessions to reduce organizational silence. Providing mindfulness-based stress reduction training and peer support groups can enhance nurses' stress management, reducing burnout.
We aimed to evaluate the performance of ChatGPT Plus and Gemini Pro, two large language model-based artificial intelligence (AI) tools, to predict actual triage levels of patients in the pediatric emergency department and compare them with the decisions of experienced nurses. This single-center, prospective observational study was conducted between September 15 and October 15, 2025. Nurses received standardized refresher training on the Emergency Severity Index (ESI) before data collection. A triage nurse assessed each patient while a pediatric emergency medicine physician simultaneously determined the gold-standard triage level; AI triage levels were recorded by a separate researcher. Patients were classified as emergent (ESI-1 and 2), urgent (ESI-3), or non-urgent (ESI-4 and 5). Agreement was evaluated using the Quadratic Weighted Kappa (κ_w) coefficient. A total of 378 patients were included. While near-perfect agreement was observed between the physician and nurses, agreement for ChatGPT Plus and Gemini Pro was moderate (κ_w 0.892, 0.586, and 0.544, respectively). The nurses had a higher triage accuracy than AI tools (92% compared to 65% for ChatGPT Plus and 63% for Gemini Pro, p < 0.001). AI tools showed a tendency toward under-triage of emergent patients and over-triage of both urgent and non-urgent patients (p = 0.038 and p < 0.001). These findings demonstrate that general AI tools are not yet sufficiently accurate to classify pediatric cases and cannot replace experienced nurses. Future hybrid AI models incorporating real-time clinical observations and age-specific physiological parameters may enhance applicability of these technologies in pediatric emergency triage.
Quantify post-traumatic stress disorder (PTSD) prevalence rates in pediatric nurses; identify the strength, direction, and predictive relationship between PTSD and psychological capital (PsyCap), psychological safety, coworker support, and supervisor support; and explore nurses' perceptions and coping strategies for dealing with work-related trauma. A convergent mixed-methods cross-sectional, correlational-predictive online research study design utilizing the Conservation of Resources theoretical framework. Convenience sample of pediatric nurses working in direct patient care in the United States. Post-Traumatic Checklist for DSM-5 (PCL-5), Psychological Capital Questionnaire (PCQ), Psychological Safety tool, Coworker Support Scale (CSS), and Supervisor Support Scale (SSS). Qualitative questions were content analyzed. Descriptive and inferential statistics, including hierarchical regression models, were used. One-hundred and seventy-one participants were included in the analysis; 56.7% met the cut-point for full PTSD criteria. PTSD symptoms were inversely related to nurses' Psychological Capital and PsyCap scores. Additionally, Psychological Safety and PsyCap were independent predictors of PTSD when entered in the hierarchical regression analysis model. A joint display table was developed to integrate qualitative and quantitative findings. PTSD is a concern for direct-care pediatric nurses. Results from the hierarchical regression analysis lend important insight into workforce factors (Psychological Safety) and intrapersonal qualities (PsyCap) affecting PTSD symptomology in pediatric nurses. Qualitative comments support the importance of coworker, leader, and organizational support for individuals. Implication to Practice This study highlights potential predictive and protective intrapersonal, interpersonal, and organizational factors on pediatric nurses' PTSD symptomology.
This study aims to investigate the levels of artificial intelligence-related anxiety among nurses, their attitudes towards the use of AI in clinical settings, their ability to maintain humanistic approaches in nursing care, and the interrelationships among these variables. This study was designed as a descriptive and cross-sectional pilot study. The sample of the descriptive study consisted of 267 nurses working in X and Y hospitals in Gümüşhane province. The data of the research was collected between December 2023 and May 2024 using the "Nurse Introduction Form", "Artificial Intelligence Anxiety Scale", "General Attitude Scale towards Artificial Intelligence" and "Humanistic Practice Ability of Nursing". Total "Artificial Intelligence Anxiety Scale" mean scores were found to be higher in nurses who were women, and had more than five years of working experience (p < 0.05). It was determined that the total "General Attitude Scale Towards Artificial Intelligence" score averages of nurses working in surgical clinics were higher than those working in pediatric clinics (p < 0.05). Positive "General Attitude Scale Towards Artificial Intelligence" mean scores were higher in nurses who had a postgraduate degree, worked in a surgical clinic, and had five years or less experience (p < 0.05). Again, the total mean of the " Humanistic Practice Ability of Nursing " was higher in nurses who had a bachelor's degree or less, and worked in management and surgery clinics (p < 0.05). It was found that nurses' artificial intelligence anxiety, general attitudes towards artificial intelligence, and ability to act humanistally varied according to some sociodemographic characteristics.
To explore the information-seeking behaviors of Iranian mothers caring for children with leukemia during the transition to home-based care. Using conventional qualitative content analysis, data were collected from two specialized pediatric hospitals in Iran between July 2023 and March 2024. Fourteen mothers were purposively selected and participated in in-depth, semi-structured interviews. The data were analyzed using Graneheim and Lundman's (2004) approach. Five main categories emerged, encapsulating the "Conscious striving of mothers of children with leukemia on a mindful journey to gain caregiving competence." These included: Mothers' persistent sensitivity and efforts to learn caregiving, Exchanging experiences with peer mothers, Seeking reassurance through interaction with healthcare professionals, Cautious use of social media, and Distrust of caregiving advice from relatives. The findings indicate that mothers of children with leukemia, during the transition of care to the home, actively recognize their child's needs and the complexities of caregiving. They play a vigilant role in seeking, critically appraising, and applying information to enhance caregiving competence. These insights can inform the development of tailored educational and supportive interventions to empower parents, improve the quality of home care, and promote better health outcomes for children. This study emphasizes the importance of personalized, family-centered oncology nursing that recognizes mothers as active partners in care. Effective support includes tailored education, peer support, and guidance in digital health literacy, while maintaining cultural sensitivity and prioritizing evidence-based practices. Providing nurses with specialized training and sufficient time is essential to ensure safer and more empowered transitions from hospital to home.
The rapid rehabilitation concept is widely adopted in adult surgery but remains underexplored in pediatric otolaryngology. This study evaluated enhanced perioperative nursing based on this concept in children undergoing endoscopic adenoidectomy. In this prospective quasi-experimental study, 102 children (aged 1 to 12 years) undergoing endoscopic adenoidectomy were allocated to an observation group (OG, n = 51) receiving enhanced perioperative nursing (preoperative psychological preparation and carbohydrate loading, intraoperative normothermia, postoperative multimodal analgesia, early nutrition, and graded mobilization) or a control group (CG, n = 51) receiving routine care. The primary outcome was pain at postoperative day 3 (FLACC scale). Secondary outcomes included hospital stay, symptom resolution, quality of life (OSA-18), complications, and parental satisfaction. The OG had significantly lower FLACC pain scores at day 3 (median 2.0 vs. 4.0; p < 0.001; r = 0.62) and shorter hospital stay (4.2 vs. 5.8 days; p < 0.001; d = 1.33). Resolution of nasal congestion, rhinorrhea, nasal flaring, and sleep snoring was significantly faster (all p < 0.001; d = 1.05 to 1.29). At 3 months, OSA-18 scores were lower across all five dimensions (all p < 0.001; d = 0.87 to 1.07). Complication rates were lower (2.0% vs. 13.7%; p = 0.028), with higher compliance (96.1% vs. 84.3%; p = 0.046) and parental satisfaction (98.0% vs. 82.4%; p = 0.007). Perioperative nursing based on the rapid rehabilitation concept improved pain control, accelerated recovery, enhanced quality of life, and increased compliance and parental satisfaction in children undergoing adenoidectomy.
Preoperative fear and postoperative pain are common problems in children undergoing surgery and may adversely affect perioperative outcomes. Nonpharmacological, child-centered interventions that support emotional preparation are increasingly emphasized in pediatric nursing care. To investigate the effects of virtual reality based aducational video on preoperative fear and postoperative pain in children aged 5-12 years undergoing surgery. This randomized controlled study was conducted in accordance with CONSORT guidelines. Seventy-four children were assigned by block randomization to the virtual reality (VR) group (n = 36) or control group (n = 38). Data were collected using a sociodemographic form, the Children's Fear Scale, and the Wong-Baker Faces Pain Rating Scale. Preoperative fear and postoperative pain were assessed at two time points by child, nurse, and researcher ratings. No significant between-group differences were found in preoperative fear scores (p > .05). However, fear scores significantly decreased after the intervention within the VR group across all evaluators (p < .001). Postoperative pain scores were significantly lower in the VR group at both assessments, as reported by parents, nurses, and researchers (p < .05 for all). VR-based education may reduce preoperative fear and postoperative pain in children aged 5-12 years undergoing surgery and represents a feasible nonpharmacological intervention in pediatric nursing care. VR-based educational interventions may support emotional preparation and pain management in pediatric surgical care. As a feasible nurse-led approach, VR can be integrated into routine preoperative practice to enhance perioperative outcomes and promote child-centered care.
This study aimed to investigate the impact of a virtual reality (VR) based educational animated film on preoperative anxiety and fear, and postoperative pain levels among children undergoing cardiac catheterization. This parallel group randomized controlled study was conducted between February and September 2025 in the Pediatric Cardiology Clinic of a university hospital in western Turkey. Children aged 5-10 years were randomly assigned to the control group (n = 21), which received standard clinical care, or to the experimental group (n = 21), which watched an animated film via VR glasses in addition to standard care. Anxiety, fear, pain, and vital signs were assessed using validated instruments. Nonparametric analyses were used for inter- and intra-group comparisons. There was no significant difference between the descriptive characteristics of the groups. However, a significant difference was found between the Children Fear Scale (CFS) and Children Anxiety Scale-State (CSA) scores of the experimental and control groups after cardiac catheterization (p < 0.05), and post-procedure CFS and CSA scores were significantly lower in the experimental group (p < 0.05). In addition, pain levels assessed using the Wong-Baker FACES Pain Scale showed a significant difference between the experimental and control groups after cardiac catheterization (p < 0.05). The study showed that watching the virtual reality-supported educational animation film significantly reduced children's pre-procedure fear and anxiety levels and alleviated their post-procedure pain levels. This result demonstrated that the use of visual-auditory, interactive, and developmentally appropriate materials is an effective method in preparing children for invasive or surgical procedures. NCT07276893https://clinicaltrials.gov/study/NCT07276893.
Sleep is crucial for pediatric recovery, but quantitative evidence on how hospitalization characteristics affect objectively measured sleep architecture is limited. This study used consumer wearables to examine how environmental, temporal, and demographic factors affect specific sleep stages. We conducted continuous sleep monitoring via wrist-worn wearables in 61 hospitalized children and adolescents, collecting 200 daily records. Multimodal analyses assessed associations between room occupancy, hospitalization duration, demographic factors (gender/age), and key sleep metrics. Environmental factors: Each additional occupant was associated with a 5.762- min reduction in light sleep duration (β = -5.762, p = 0.004) and a 3.813-min increase in REM sleep duration (β = +3.813, p = 0.002). High-density rooms (with >4 occupants) were further linked to longer daytime nap duration (p = 0.022). Temporal factors: Wakefulness duration followed a U-shaped pattern across hospitalization duration, peaking in both short-stay (1-3 days) and extended-stay (≥ 8 days) groups, with significantly lower wakefulness in the medium-stay group (4-7 days, p = 0.006). Demographic factors: Females exhibited longer deep sleep duration compared to males (p = 0.023). No significant differences were observed across age groups (all p > 0.05) CONCLUSION: Room occupancy, length of stay, and gender were each associated with distinct alterations in specific sleep stages among pediatric inpatients. Reducing the use of high-density rooms and implementing dynamic, gender-sensitive sleep care protocols may help preserve restorative sleep. These environmental and temporal factors can be incorporated into the design of daily care routines and ward layouts.
Upper limb disorders, including carpal tunnel syndrome (CTS), are a common cause of pain, functional limitations, and reduced quality of life. Increasing attention has been directed toward the role of inflammatory and angiogenic mediators in the pathophysiology of CTS and their potential relationship with patient-reported functional outcomes. The aim of this study was to evaluate selected cytokines as potential markers of upper limb disability assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. This cross-sectional study included 55 patients with idiopathic CTS referred for surgical treatment. Functional impairment was assessed using the DASH questionnaire, and concentrations of selected inflammatory and angiogenic mediators-IL-4, IL-6, MCP-1, TNF-α, VEGF, and fraktalkine-were measured in synovial tissue samples; these markers were selected based on their established roles in inflammation, angiogenesis, and nociceptive modulation relevant to CTS pathophysiology. VEGF was identified as a significant predictor of DASH category (p = 0.032), with higher concentrations associated with a lower likelihood of severe upper limb dysfunction. In contrast, higher TNF-α levels were associated with an increased risk of severe disability (p = 0.031). Other cytokines did not demonstrate significant associations with functional impairment. These findings suggest that selected inflammatory and angiogenic mediators were associated with the severity of functional disability in CTS and warrant investigation in prospective longitudinal studies to clarify their potential role alongside patient-reported outcome measures.
To develop and preliminarily validate a questionnaire assessing primary care nurses' practices, perceptions, and perceived barriers in managing childhood obesity. Sequential exploratory study conducted in three phases: item development, content validation, and a cross-sectional observational study with an initial psychometric validation. Items were generated through a literature review, focus groups, and adaptation of an existing adult obesity instrument. A panel of six experts assessed content validity, clarity, coherence, and item adequacy. The final version 39-item questionnaire was distributed online to primary care nurses in Madrid, Spain; 253 complete responses were analyzed. Descriptive statistics were calculated. A preliminary Exploratory Factor Analysis was conducted on selected items. The overall content validity index was 0.96. The final instrument identified three areas: training and experience, practices and barriers, and knowledge of childhood obesity. Factor analyses supported coherent underlying dimensions for selected items, with acceptable internal consistency. Nurses reported positive attitudes toward addressing pediatric obesity but identified barriers such as limited consultation time, low treatment adherence, and intervention complexity. The NPPBQ-CO is a structured instrument with initial evidence of content validity, preliminary psychometric support and acceptable internal consistency. Further validation is warranted.
Children diagnosed with bone tumors or soft tissue sarcomas often undergo limb salvage surgery or amputation, procedures that shape long-term functioning and quality of life (QOL). Patient-reported and caregiver-reported outcomes (PROs) provide essential insight into physical, psychosocial, and participation impacts, yet existing evidence is dispersed and methodologically heterogeneous. This scoping review mapped the PRO literature for children, survivors, and caregivers following cancer-related limb surgery and identified gaps limiting clinical care and research advancement. Six databases were searched. Eligible studies included children with bone or soft-tissue sarcomas and their family caregivers that reported PROs or needs related to limb salvage or amputation. Two reviewers independently screened studies and charted data. Quantitative and qualitative findings were summarized descriptively and synthesized narratively across QOL domains. Twenty-seven studies fulfilled inclusion criteria. Physical functioning was the most assessed domain, with generally moderate-to-good outcomes and limited differences between limb salvage and amputation. Pain remained common months to years post-surgery. Psychosocial findings were mixed, reflecting peer acceptance but also body image, recreation, and school participation challenges. Only four studies included caregivers, who reported anxiety, depression, financial strain, and shifting family roles. Across studies, PRO measurement was highly heterogeneous, with inconsistent domains of assessment, measurement tool use, and timepoints. Children and families experience complex functional and psychosocial impacts after limb surgery, underscoring needs for enhanced rehabilitation, pain care, school reintegration, and caregiver support.
To explore the relationships between moral courage, moral resilience, and ethical behavior among pediatric nurses, and to examine the mediating effects of moral resilience in the relationship between moral courage and ethical behavior. A quantitative, multicenter, cross-sectional study. A total of 327 Chinese pediatric nurses from 13 public hospitals completed an online survey. They completed the Nurses' Moral Courage Scale (NMCS), the Rushton Moral Resilience Scale (RMRS), and the Ethical Behavior Scale for Nurses (EBSN). The mediating effect of moral resilience was assessed using the bootstrap method through IBM SPSS Amos 26.0. Pediatric nurses' moral courage was positively associated with moral resilience (r = 0.485, p < 0.001) and ethical behavior (r = 0.448, p < 0.001); both moral courage and moral resilience were directly associated with ethical behavior, with moral resilience mediating this relationship. Moral courage has a positive effect on ethical behavior among pediatric nurses, and this relationship is further strengthened through moral resilience. These findings underscore the importance of integrating ethics education and resilience-building strategies into nursing management and professional development programs to promote sustained, high-quality ethical practice. This study provides a practical basis for strengthening ethical practice among pediatric nurses. It highlights the need for targeted strategies to enhance nurses' moral courage and moral resilience, particularly through structured ethics education and resilience-building programs. Future longitudinal studies with larger and more diverse samples are needed to examine the pathways through which moral courage and moral resilience influence ethical behavior.