Artificial intelligence (AI) is becoming an integral part of nursing education; however, the perspectives of graduate nursing students on its use remain underexplored. This study aimed to examine graduate nursing students' views on AI in nursing education. A qualitative phenomenological design incorporating the photovoice method was adopted. Fifteen graduate nursing students from a state university were recruited between 01 March 2025 and 30 May 2025. Data were analyzed using thematic analysis in accordance with Braun and Clarke's approach. Analysis yielded five main themes and 17 subthemes: (1) Areas of AI application in nursing education, (2) Perceived advantages of AI, (3) Perceived disadvantages of AI, (4) Recommendations for effective AI integration in nursing education, and (5) Future directions for AI in nursing education. Participants viewed AI as a tool to enhance the quality and effectiveness of nursing education, while emphasizing the importance of ethical sensitivity and protection of professional identity. The use of photovoice method enriched and deepened these insights.
This study explores nursing educators' perspectives on the challenges and benefits of integrating generative artificial intelligence (AI) into nursing education. There is little empirical evidence on how educators perceive these technologies and how such perceptions influence their integration into curriculum design, teaching practices, assessment, and student research and learning. Exploratory-descriptive qualitative study underpinned by the Actor-Network Theory. Four focus group sessions were conducted with ten nursing educators across Australia, New Zealand, Austria and Hong Kong. Data were collected via Zoom, transcribed verbatim, and analysed thematically using Braun and Clarke's six-step reflexive framework. The nurse educators included five women and five men. Ages ranged between 25 and 64 years and a mean 8.75 [SD ±6.36] years of experience as an educator. Three main themes were constructed based on focus group discussions: (1) The AI Dilemma, revealing tensions surrounding academic integrity, policy ambiguity and ethical concerns; (2) The AI Toolkit, identifying pedagogical benefits alongside challenges to critical thinking development; and (3) Educator's AI Odyssey, exposing disparities in institutional preparedness and educator competence. Whilst AI was recognised for enhancing engagement and efficiency, substantive concerns persisted regarding equity, ethical implementation and organisational readiness. Generative AI presents a paradox in nursing education. Whilst it enables innovation and personalised learning, it poses risks to academic integrity and deep learning when implementation lacks ethical consideration and pedagogical rigour. AI-enhanced nursing education must safeguard fundamental nursing values, critical thinking capabilities, ethical reasoning and clinical judgement to ensure the delivery of safe, competent patient care. Educational and institutional policies must facilitate balanced, ethical and equitable integration of AI in nursing education. The Consolidated Criteria for Reporting Qualitative Research (COREQ). No patient or public contribution.
Traditional 24-hour call systems in surgical training often result in educational fragmentation, with post-call days causing interruptions in operative experience, particularly for senior residents. By contrast, night float systems may help reduce interruptions. This study evaluates the implementation of an intern night float rotation in a neurosurgery residency program and assesses perspectives on educational value and patient safety. An intern night float system was implemented at Massachusetts General Hospital (a tertiary care center) from April to June 2024. Interns provided in-house overnight coverage, managing >50% of admitted neurosurgery patients. Senior residents on home call provided supervision, performed procedures overnight as needed, and subsequently returned for a regular operative experience the following day. Participants' perspectives were evaluated through Likert-scale surveys administered to attending faculty (n = 5), senior residents (n = 3), junior residents (n = 3), and neuroscience nursing staff (n = 23). Interns (n = 6) completed retrospective open-ended surveys. Outcomes included perceived patient safety, educational value, and nursing satisfaction with communication. Improvement in perceived patient safety was rated highly by faculty/residents (median 5/5) and nursing staff (median 4/5). Faculty/residents also rated educational value highly (median 5/5), with 100% agreeing or strongly agreeing that the rotation provides valuable learning for residents. Qualitative responses highlighted accelerated intern readiness for PGY-2 responsibilities and protected operative time for senior residents. Nursing staff reported improved ability to escalate concerns (78% agreement) and better response times (78% agreement) after the implementation of the night float rotation. More variability was observed in nursing responses regarding appropriate triage of pages (61% agreement, 39% neutral). An intern night float rotation received positive feedback from faculty, residents, interns, and nursing staff regarding patient safety. The rotation provided educational opportunities for interns and improved operative experience for senior residents. This study suggests that intern night float models can align educational needs across training levels without affecting perceived patient safety.
: Artificial intelligence offers transformative potential for nursing practice, yet significant barriers hinder adoption. While existing research has documented challenges among practicing nurses, limited evidence exists regarding nursing students' perspectives; they are the generation that will shape artificial intelligence's future role in healthcare. : To explore barriers and facilitators to artificial intelligence adoption among nursing students using a mixed-methods approach, examining relationships between technological readiness, ethical concerns, and perceived usefulness of artificial intelligence in nursing practice. : Explanatory sequential mixed-methods study combining quantitative surveys with qualitative semi-structured interviews. College of Nursing, Taibah University, Medina, Saudi Arabia (November 2024-March 2025). 348 nursing students across academic levels 3-8 participated in the quantitative phase (response rate: 72.5%), with 17 students purposively selected for qualitative interviews. Validated instruments - the Technology Readiness Index 2.0, an adapted Perceived Usefulness Scale, and an Ethical Concerns Scale - were administered online. Kendall's tau correlation and partial proportional odds modeling identified predictors of perceived usefulness. Qualitative data underwent thematic analysis using Braun and Clarke's framework. Trustworthiness was addressed through investigator triangulation, an audit trail, reflexive memoing, and member-checking. Mixed-methods integration followed a joint-display framework to examine convergence between quantitative and qualitative findings. Technological optimism (Kendall's tau [τ] = 0.45, 95% confidence interval [CI]: 0.39 to 0.50, p < 0.001) and innovativeness (τ = 0.41, 95% CI: 0.35 to 0.47, p < 0.001) showed strong positive associations with perceived artificial intelligence utility. Paradoxically, moderate ethical concern predicted higher perceived usefulness (adjusted odds ratio for perceiving low utility = 0.19, 95% CI: 0.09 to 0.40, from the partial proportional odds model). From the qualitative analysis, we revealed universal concern about deskilling (100% of interviewees), data privacy risks (94%), and erosion of human connection in patient care. Participants proposed shared decision-making models where artificial intelligence provides recommendations while nurses retain final clinical authority. The lack of nursing-specific artificial intelligence tools emerged as a critical barrier. Nursing students in this Saudi sample demonstrated nuanced perspectives on artificial intelligence adoption, characterised by cautious optimism alongside critical awareness. The paradoxical relationship between ethical concern and perceived utility challenges traditional technology acceptance models, suggesting deeper engagement fosters appreciation of both opportunities and challenges. We have underscored the importance of tailored educational strategies addressing technical competencies alongside ethical reasoning and professional identity formation. As this generation of digitally fluent students transitions into nursing practice, the perspectives of this sample offer insights for developing artificial intelligence integration approaches that preserve nursing's humanistic core while leveraging technological capabilities.
Postoperative pulmonary exercises are crucial for recovery after coronary artery bypass grafting (CABG). However, traditional face-to-face education often fails to translate into sustained patient adherence. While continuous educational support is essential throughout hospitalization and post-discharge, mobile-based platforms offer a promising, accessible avenue to bridge this gap. This study explored the perspectives of post-CABG patients and healthcare professionals (HCPs) on the requirements for a mobile-based educational intervention to guide its development. This is a descriptive qualitative study conducted at a Malaysian public tertiary cardiac center between January and March 2025. Using purposive sampling, 12 patients with CABG and 14 HCPs from cardiothoracic surgery and rehabilitation medicine departments were recruited. Data were collected via face-to-face, semi-structured interviews and analyzed using inductive content analysis. Three key themes were identified: (1) the need for supportive education throughout the care continuum, (2) high readiness to adopt mobile-based learning, and (3) the importance of application usability and personalization. Both patients and HCPs valued continuous education and were receptive to a mobile-based solution. Participants preferred video-based demonstrations, multilingual content, and a user-friendly interface to enhance engagement. A mobile application may be a feasible and preferred platform for supplementing routine education on post-CABG pulmonary exercises. Despite concerns regarding age and digital literacy, stakeholders supported its real-world implementation to evaluate its potential to enhance patient engagement and foster self-directed recovery.
AI-powered chatbots offer new opportunities to enhance patient education; however, their integration may reshape patterns of information interactions and trust relationships among patients, caregivers, and nurses. Evidence remains limited on how these stakeholders perceive the value and risks of AI-powered chatbots, and on their potential effects on nurse-patient trust. This study explores patients', caregivers', and nurses' attitudes toward and experiences with integrating AI-powered chatbots into patient education and identifies perceived benefits, implementation challenges, potential effects on trust, and the supportive conditions required for safe integration. This qualitative study was conducted from April to July 2025. Patients and caregivers were recruited from a tertiary general hospital using maximum variation purposive sampling, while nurses were recruited through snowball sampling from 6 hospitals of varying tiers. Data were collected using a sociodemographic questionnaire and semistructured, in-depth interviews. Interview recordings were transcribed verbatim and analyzed using reflexive thematic analysis, with NVivo used for coding and theme development. Sociodemographic data were analyzed descriptively. A total of 60 participants were included: 29 patients, 17 caregivers, and 14 nurses. Four themes were identified: perceptions and maintenance of nurse-patient trust, conditional acceptance and practical needs, functional optimization and implementation safeguards, and nurses' role pressures and competency restructuring. All 3 stakeholder groups recognized the potential of AI-powered chatbots to address unmet information support needs in patient education but expressed reservations about their accuracy, personalization, and transparency. AI-powered chatbots were not perceived as a direct threat to nurse-patient trust. However, nurses were more sensitive to potential trust tensions, increased explanation burden, and expanded professional responsibilities, highlighting the need for competency restructuring. Stakeholder groups also differed in their perceptions of the conditions required to maintain nurse-patient trust. Limited digital health literacy and the digital divide affecting older patients were major barriers to integrating AI-powered chatbots into patient education. Patients, caregivers, and nurses were generally cautiously open to integrating AI-powered chatbots into patient education, although their assessments of benefits and risks differed by role. AI-powered chatbots may be best positioned as adjunctive information-support tools. Their safe use should be tailored to patient characteristics, information risk, and clinical context, with nurses' professional oversight and coordinated support across governance, technical, and clinical implementation levels.
Background/Objectives: The Bologna Process and the European Higher Education Area consolidated the transition of nursing education in Spain from diploma-level training to a university degree framework. Although previous research has examined newly graduated nurses' transition to practice, less attention has been paid to how key informants involved in educational reform interpret its long-term professional implications, including their potential relevance for nurses' well-being. This study explored key informants' perspectives on the implications of the Bologna Process and the Nursing White Paper on nursing education and professional development in Spain. Methods: An exploratory qualitative study was conducted using in-depth semi-structured interviews with six key informants involved in nursing educational reform in Spain. Interviews were conducted between June and November 2025, audio-recorded, transcribed verbatim, and analyzed using reflexive thematic analysis. Results: Three main themes were identified: (1) academic professionalization and the generation of professional expectations; (2) structural misalignment between university-based professionalization and clinical practice; and (3) Reality Shock, professional identity and nurses' well-being. Conclusions: From the perspective of key informants, Reality Shock may be understood not only as an individual transition difficulty, but also as a possible expression of structural misalignment between academic professionalization and healthcare organizations. These findings suggest that strengthening nurses' well-being may require organizational strategies that translate educational reform into professional recognition, autonomy, leadership opportunities, and coherent career development.
Digital therapeutics (DTx) are evidence-based, software-driven interventions that are expanding rapidly worldwide. However, current research has largely marginalized the nursing perspective, restricting the theoretical framework of DTx to clinical interventions rather than the fundamental caring relationship. This literature review, grounded in the core tenets of nursing care and ethics, was developed to synthesize five paradoxes inherent to DTx. These include: relational caring versus digital mediation; clinical judgment versus algorithmic decision-making; care ethics versus data compliance; workload relief versus digital administrative burden; and professional autonomy versus algorithmic governance. To address these tensions, a comprehensive four-stage nursing engagement framework is proposed that spans the entire DTx lifecycle of design, implementation, evaluation, and ethical governance. Furthermore, "integration" is reconceptualized as a dual-layered construct, highlighting the indispensable role of nurses in the clinical deployment of DTx. Finally, strategic recommendations are provided covering the dimensions of practice, education, research, and policy with the goal of actualizing a future of technology-empowered professionalism and humanistic care. 數位療法的兩難與共融—護理照護與照護倫理的視角. 數位療法（digital therapeutics, DTx）是基於臨床實證以軟體驅動、具治療目的介入的產品，目前在全球快速發展，現有多數探討DTx之相關研究忽視護理視角，使DTx之理論架構止步於醫療介入而非照護關係上。本文以護理照護與照護倫理為核心視角，透過文獻探討綜整五項DTx兩難困境：照護關係vs.數位中介、臨床判斷vs.演算法決策、照護倫理vs.數據合規、工作減負vs.數位行政增量、專業自主vs.演算法治理；並據此提出涵蓋DTx全生命週期之護理參與四階段框架—設計、實施、評估、倫理治理。將共融定義提升至雙層複合概念，強調護理角色於DTx導入臨床場域之重要性及其核心地位。最後，從實務、教育、研究、政策四層面提出相關建議以實現以科技賦能專業、以人性遞送照護之願景。.
Practice education is an essential component of occupational therapy programmes in Australia, providing supervised opportunities for students to develop skills across diverse practice settings. Rising student enrolments have intensified pressure on universities to secure sufficient practice education opportunities, prompting exploration of alternative models and emerging settings. The research setting, with supervision provided by occupational therapists working in research roles, presents a promising but under-utilised option for practice education. This study aimed to explore the perspectives and experiences of occupational therapy and physiotherapy students, practitioners, and university educators on placements in a research setting. Semi-structured interviews (n = 30) were conducted with occupational therapy and physiotherapy students, practitioners with experience working in research-specific roles, and university educators. The Theoretical Domains Framework guided the development of the interview schedules. Participants were recruited using purposeful and snowball sampling. Data were analysed thematically. The interview schedule was developed in consultation with research practitioners and university educators. Practice education is occurring within research settings, though it is not yet common, with generally positive perceptions reported among those involved. Participants viewed these placements as an opportunity to strengthen research confidence, develop research readiness, and generate interest, alongside meeting core placement competencies. For some participants, practice education in a research setting was a new concept. University educators questioned whether all research settings could satisfy accreditation requirements. Seven themes were identified: research confidence, professional responsibility, sparking interest, missed opportunity, accreditation requirements, fear of missing out on client contact, and risks to the research quality. Utilisation of the research setting for practice education may strengthen students' understanding of how evidence is generated and translated into practice, helping to address persistent concerns about low research confidence and engagement. Effective implementation will require collaboratively developed models that reflect the needs of all stakeholders. Ongoing trial and evaluation are essential to determine feasibility, educational value, and impact. Practice education or ‘placements’ are a key part of becoming an occupational therapist in Australia. Placements give students the chance to learn real‐world skills under the guidance of qualified practitioners. As the number of students grows, it has become harder for universities to find enough suitable placement opportunities. One possible solution is to offer placements in research settings, where students are supervised by allied health practitioners working in research roles. This study explored what occupational therapy and physiotherapy students, practitioners, and university educators think about placements in research settings. Thirty people were interviewed, sharing their experiences and views. Ideas shared in the interviews were sorted into seven main groups: research confidence, professional responsibility, sparking interest, missed opportunity, accreditation requirements, fear of missing out on client contact, and risks to the research quality. Most participants felt that these placements could help students build confidence with using research, learn important skills, and become more interested in research as part of their future careers. However, some participants were unsure whether all research settings would offer enough opportunities for students to develop and demonstrate the necessary skills of a graduate occupational therapist or physiotherapist. Some participants described positive experiences with placements in research settings, whereas others had neither undertaken nor previously considered such placements. Overall, the study found that placements in research settings could help students better understand how research is created and used in their future work roles. For these placements to work well, universities, practitioners, and students will need to work together to design and test potential models.
The implementation of advance care planning (ACP) has traditionally been confined to medical officers and specialist nurses. This study evaluated the effect of a multimodal Advance Care Planning Education (ACPEd) program for allied health professionals and generalist nurses. Conducted within a regional health service in Queensland, Australia, the study used a single-arm, explanatory sequential mixed methods design involving 30 participants completing a three-hour workshop, and a learning circle attended by 10 participants. Quantitative data were collected through preintervention and postintervention surveys assessing perceived confidence, knowledge, skills, and role legitimacy. Qualitative data from the learning circles explored changes in clinical practice and role identity. Significant improvements were observed in confidence, t (29) = -7.820, P= <.001; knowledge, t (27) = -12.87, P= <.001; and skills, t (29) = -6.814, P= <.001. There was no significant change in perceived health professional roles, t (26) = 2.182, P= .19, indicating a strong belief that all health professional groups have a role in ACP. Three overarching themes emerged: prioritizing ACP, recognizing role legitimacy, and evolving perspectives on engagement. Despite persistent barriers including time constraints and team dynamics, participants demonstrated increased capacity and intent to initiate ACP discussions, with the ACP Tracker a key facilitator for clinical care. The findings suggest that targeted, interprofessional education may support the development of role identity and legitimacy for ACP among allied health professionals and generalist nurses. The ACPEd program is a scalable model for embedding ACP into practice, with implications for policy and professional development.
In Saudi Arabia, nurses have long lacked a formally defined scope of practice, contributing to role ambiguity and role overlap. In 2023, the Saudi Commission for Health Specialties (SCFHS) released the first national Scope of Nursing and Midwifery Practice document. This study explored how nurse managers and supervisors perceived the scope of practice following this update in Makkah Cluster Hospitals. As the second, explanatory phase of a larger sequential explanatory mixed-methods study, a qualitative descriptive study was conducted between May and August 2025 with 20 nurses in managerial roles (Nursing Directors, Nursing Supervisors, and Head Nurses) at two hospitals within the Makkah Health Cluster. Participants were selected through purposive sampling, restricted to managerial and supervisory positions to capture a cross-departmental, organizational perspective on scope enactment. Interviews were conducted via Zoom in Arabic, translated into English, and analyzed using inductive thematic analysis consistent with the approach of Braun and Clarke. Trustworthiness was addressed through credibility, transferability, dependability, and confirmability, with reporting guided by the Consolidated Criteria for Reporting Qualitative Research (COREQ). Four themes emerged from the accounts of the 20 participants (10 men and 10 women from both hospitals): (1) expanding the scope of nursing practice, (2) bridging the gap between training and practice, (3) overcoming barriers to full professional practice, and (4) promoting nurse empowerment and accountability. Participants described a tension between a formally defined scope and inconsistent enactment across departments and shifts. Unclear job descriptions, administrative constraints, staffing shortages, and resource deficits were the primary barriers, whereas autonomy and continuous development were identified as essential enablers. The nurse managers and supervisors in this study perceived the scope of nursing practice as variably enacted and frequently constrained following the 2023 SCFHS update. These findings suggest that regulatory publication alone may be insufficient, highlighting the need to operationalize the framework through revised job descriptions, simulation-based professional development, adequate staffing, and leadership-supported autonomy aligned with Saudi Vision 2030. Because these findings reflect the perspectives of nursing leaders rather than bedside clinical nurses, their application to direct patient care contexts should be interpreted with appropriate caution.
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The purpose of this study was to examine the relationship between undergraduate nursing student burnout and faculty immediacy behaviors. Undergraduate nursing students in the United States are experiencing burnout syndrome at alarming rates. There have been many attempts to improve the issue in this population, but few focus on the impact that nursing faculty have on student burnout. A quantitative, nonexperimental, correlational research design was used. Data were collected from Bachelor of Science in Nursing students using three valid and reliable survey tools. Statistical analysis revealed the existence of a significant relationship between faculty nonverbal immediacy and all three tenets of student burnout (emotional exhaustion, cynicism, and academic efficacy). A statistically significant relationship between verbal immediacy and academic efficacy also existed. This research demonstrates that nursing faculty who engage in immediacy behaviors may have a positive impact on the experiences of undergraduate nursing students.
This study aims to examine how self-leadership and caring can be conceptually integrated to strengthen the legitimacy of nursing clinical judgement in complex healthcare environments. This study adopts a conceptual analysis design. A conceptual analysis approach was used to synthesise theoretical perspectives from self-leadership scholarship and caring theory to clarify the internal conditions that support accountable clinical decision-making. Self-leadership was selected because it offers a framework for understanding the self-regulatory processes underlying intentional professional action, whereas caring theory conceptualises nursing as a moral-relational practice grounded in human dignity and ethical responsibility. Integrating these theories enabled examination of how regulatory capacity and moral orientation converge to strengthen relational accountability in nursing clinical judgement. This conceptual analysis proposes a relational accountability framework comprising three interrelated components: regulatory reflexivity, moral-relational orientation and accountable enactment. Regulatory reflexivity supports intentional reasoning and behavioural alignment, moral-relational orientation directs decision-making towards relational responsibility and patient dignity and accountable enactment reflects the transparent communication and justification of clinical decisions within relational care contexts. Relational accountability offers a theoretical basis for strengthening the legitimacy of nursing clinical judgement by integrating internal regulatory capacity with caring-based ethical orientation. The framework provides directions for future empirical inquiry into accountable decision-making in nursing practice. No patient or public contribution.
Impostor phenomenon (IP) is widely recognised among doctoral candidates but remains insufficiently understood, particularly within nursing academia. It is commonly framed as an individual deficit, overlooking the broader social and linguistically mediated experience that shapes scholarly identity. This discursive exploration draws on Fairclough's Critical Discourse Analysis (CDA) to examine micro, meso and macro social orders across diverse textual sources and reflexive accounts, exploring how language and institutional norms position nursing doctoral candidates as impostors. Findings reveal tensions between professional, social and ideological expectations and the formation of a doctoral nurse identity, where dominant discourses individualise systemic constraints, reproduce hierarchies and marginalise nursing expertise through gendered, caring and knowledge-ownership narratives. Doctoral preparation can disrupt these dynamics by fostering visibility, authority and knowledge production, yet limited support and persistent hierarchies intensify impostor subjectivities. Shifting from deficit framings to critical discourse perspectives enables supervisors, institutions and candidates to cultivate relational, reflective and inclusive practices that mitigate impostor experiences and strengthen nurse-academic identity. Doctoral education thus becomes a vehicle for structural transformation, advancing nursing's research leadership, policy influence and patient care outcomes.
The quality of discharge processes impacts adverse outcomes post hospitalization for children with medical complexity (CMC). Perspectives of caregivers at risk for communication challenges (eg, non-English speakers, those with limited health literacy, immigrants) on understandability and feasibility of discharge instructions for CMC are understudied. Our objective was to explore their perspectives on barriers and facilitators to comprehension and implementation of discharge instructions for CMC. In this qualitative, descriptive study, we used maximum variation sampling to enroll caregivers of CMC (N = 40) discharged from acute or intensive care units of 2 urban hospitals. English- and Spanish-speaking caregivers of CMC (Pediatric Medical Complexity Algorithm) aged 18 years or older and discharged on 1 or more daily medications were eligible. We conducted semistructured interviews, audio-recorded and transcribed interviews, and performed content analysis. Two team members applied codes from a codebook (developed based on prior literature and preliminary analyses) and identified emerging themes. Equal numbers of participants spoke English and Spanish (n = 20 per language) and were recruited from each hospital (n = 20 per hospital). Half (47.5%) had low health literacy; 85% were of non-US birth. Themes emerged across 4 categories: (1) clinician and medication access; (2) patient- and family-centered approaches to discharge planning and education; (3) caregiver prior experience; and (4) resources and support systems. Caregivers identified barriers and facilitators affecting discharge plan comprehension and implementation. Optimizing postdischarge care for CMC is complex and requires family-centered, language-concordant, and health literacy-informed processes. Future interventions should focus on systems-level changes that enhance access and account for caregiver perspectives.
Bell-ringing rituals mark the end of active cancer treatment in oncology settings worldwide. Despite their growing prevalence, their emotional and clinical implications across patients, caregivers, and healthcare professionals remain underexplored. To map and synthesize the available evidence on bell-ringing rituals in cancer care, examining their meanings and implications from the perspectives of patients, informal caregivers, and healthcare professionals. A scoping review was conducted following Joanna Briggs Institute methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines (Open Science Framework protocol: https://doi.org/10.17605/OSF.IO/UCPFV). Five databases (PubMed, Scopus, Embase, CINAHL, and Cochrane Library) were searched from January 1996 to July 2025. Qualitative, quantitative, and mixed-methods studies were eligible. Two independent reviewers performed selection, extraction, and thematic synthesis. Five studies met the inclusion criteria. Four themes emerged: (1) symbolic closure and transition, (2) emotional ambivalence encompassing joy, guilt, and anxiety, (3) visibility, recognition, and disparities, and (4) absence of institutional guidance. While many patients experienced achievement and community, those with ongoing treatments or advanced disease frequently reported exclusion and distress, including posttraumatic stress disorder triggers. Bell-ringing rituals support meaning-making for some patients but may unintentionally marginalize vulnerable individuals when implemented without adequate assessment. No evidence-based protocols currently exist for patient readiness or cultural appropriateness. Oncology nurses should conduct preritual readiness assessments and offer individualized symbolic options to protect nonparticipating patients. Findings support inclusive institutional protocols and the integration of ritual literacy into nursing education.
Male involvement in sexual and reproductive health (SRH) though a relatively old concept in Ghana continues to evolve traditionally focusing on women's health. The World Health Organization has encouraged gender-inclusive maternal health services to leverage men's roles in supporting their partners' health. This study aims to explore the perspectives of nurses and midwives on male involvement in SRH, identifying benefits, challenges, and strategies for enhancement. A qualitative exploratory design was employed in Greater Accra Region, Ghana, engaging 32 nurses and midwives through five focus group discussions. Data collection involved using a semi-structured interview guide and recorded interviews. Data analysis was based on Braun and Clark's thematic analysis framework. Findings revealed three primary themes: benefits of male involvement, barriers to participation, and strategies to enhance engagement. Participants noted significant positive outcomes, including improved health outcomes for women, reduced complications due to emotional and logistical support by male partners. However, barriers such as cultural norms, societal expectations and inadequate knowledge hindered active male involvement. This notwithstanding, participants have a strong desire to promote male involvement. Results underscore the necessity of comprehensive education and community engagement to reshape attitudes towards male involvement. The lack of formal training for healthcare providers on facilitating male participation was identified as a critical gap. Enhancing male involvement in SRH can significantly improve maternal health outcomes. Nurses and midwives play a pivotal role in promoting this initiative through targeted education, outreach programs, and policy advocacy, ultimately fostering healthier family dynamics in Ghanaian society.
Hospitals are known to have a significant carbon footprint, particularly in high-income countries, yet evidence on patients' view regarding mitigation initiatives within hospital policy is limited. To examine patients' perspectives on a Dutch hospital-led environmental sustainability policy related to healthy nutrition, waste reduction, sustainable mobility, and disease prevention by lifestyle interventions. A cross-sectional online survey was conducted in October 2024 among members of a patient panel from a Dutch tertiary University Medical Centre. The survey included four closed-ended questions and one open-ended question on important environmental sustainability initiatives. Descriptive statistics were used, associations between demographics (sex, age, education) and perceived importance were assessed using Chi-square tests and logistic regression. Qualitative responses underwent thematic content analysis. Of the 2473 invited patients, 1285 (52%) responded to the closed-ended questions and 742 (30%) provided open-ended responses. Disease prevention was rated most important (88%), followed by waste reduction (82%), healthy nutrition (76%), and sustainable mobility (58%). Older age and level of education were significantly associated with perceived importance. Additional themes for hospital policy include medication use, energy consumption, and awareness. Patients generally support environmental sustainability initiatives in hospital-led policy, particularly those promoting disease prevention, waste reduction, and healthy nutrition. They also identify opportunities for policy development, such as circularity strategies to retain the value of health care products and health promotion strategies focusing on nutrition and lifestyle. Future research should explore how patients wish to participate in shared decision-making on environmental sustainability.
Co-occurring mental health and substance use disorders remain a major challenge for treatment and recovery in low-resource settings where services are often fragmented. People with these conditions usually receive care in systems with limited coordination, financial barriers and stigma. Our study explored the treatment experiences of individuals with co-occurring disorders and the perspectives of mental health workers. A qualitative exploratory design was used to examine the treatment experiences of service users with co-occurring mental health and substance use disorders and the perspectives of mental health workers. Guided by an interpretivist approach and reflexive thematic analysis, 24 service users and 10 mental health workers were purposively selected. Data were collected through semi-structured interviews between December 2025 and March 2026, audio-recorded, transcribed verbatim and analysed using NVivo 12. The study adhered to the COREQ: a 32-item checklist to ensure rigour, transparency and trustworthiness. Five interconnected themes emerged: fragmented and unstable treatment pathways, hidden economic burden of care and relapse cycles, stigma and social withdrawal, emotional exhaustion and psychological distress and health system constraints with gaps in community follow-up. Participants described care as discontinuous, characterised by repeated cycles of relapse and re-engagement, financial hardship and weak coordination between services. Stigma at family and community levels discouraged timely help-seeking. Mental health workers highlighted systemic constraints, including inadequate staffing, transport challenges and inconsistent outreach services. There was strong agreement between service users' experiences and health workers' accounts of system-level challenges. Treatment experiences are shaped by interacting social, economic and health system factors that disrupt continuity of care. Strengthening integrated, person-centred mental health and substance use services, alongside improved community follow-up and psychosocial support, is essential to improving outcomes in similar low-resource settings. Service users with lived experience of co-occurring mental health and substance use disorders participated in this study and contributed to the development of interview topics by sharing priority areas of concern during data collection. Their perspectives informed the interpretation of findings alongside mental health workers. There was no formal involvement of patients or the public in study design or manuscript preparation.