Nursing ethics guides practice, but European Union national codes were developed in diverse socio-legal contexts, generating heterogeneous emphases. To compare European Union nursing codes of ethics, mapping convergences, divergences, and emerging ethical dimensions. Qualitative documentary analysis with thematic content analysis examined 22 European Union member-state codes plus the European Nursing Council and International Council of Nurses (ICN) codes, with input from nursing, qualitative, and health-law experts. Fourteen themes were identified: Dignity, Respect and Non-Discrimination; Autonomy and Informed Consent; Professional Secrecy and Data Protection; Safety and Evidence-Based Practice (EBP); Interprofessional Collaboration and Shared Responsibility; Protection of Vulnerable Groups and Violence Prevention; Palliative Care and Dignity at the End of Life; Conscientious Objection and Continuity of Care; Technologies and Artificial Intelligence; Environmental Sustainability and Public Health; Social Justice and Advocacy; Organizational Well-being; Governance, Integrity, and Professional Discipline; Training and Professional Development. Fundamental principles showed strong convergence, while newer areas (AI, One Health, organizational well-being) appeared unevenly. The findings suggest the existence of a shared ethical core across European nursing while highlighting differences in the formalization of emerging ethical challenges. These variations may reflect contextual priorities, regulatory traditions, and different stages of ethical adaptation across national frameworks. This study provides an updated overview of the European nursing ethics landscape and may inform future discussions on the evolution of ethical guidance in response to contemporary healthcare challenges while respecting national contexts.
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.
Teachers' instructional strategies and students' learning styles are key determinants of learning effectiveness. This study examined whether the World Cafe teaching strategy and the Four-Topic Approach to ethical decision-making could enhance outcomes in nursing ethics education. A total of 250 nursing students participated in this study. Two instructional strategies were implemented during the semester: (1) the World Cafe teaching strategy and (2) the Four-Topic Approach. Pretests and post-tests were administered. Learning-style classifications included visual (n = 106), auditory (n = 96), and kinesthetic (n = 124). Additionally, 50 students demonstrated a single learning style, 54 demonstrated two learning styles (eg, visual-auditory, auditory-kinesthetic, or kinesthetic-visual), and 56 demonstrated all three learning styles (visual, auditory, kinesthetic). Eighty-eight students could not be assigned to any learning-style category. Overall, 110 students (44%) exhibited two learning styles. Significant correlations were observed between the use of multiple teaching strategies and nursing students' learning styles (r = 0.352, p = .01), as well as between teaching strategies and moral sensitivity (r = 0.329, p = .01). Both learning styles and instructional strategies were associated with improved moral sensitivity scores. The findings suggest that integrating diverse teaching strategies - such as the World Cafe and structured ethical decision-making - can effectively enhance nursing ethics education. Tailoring instruction to accommodate students' learning styles may contribute to improved moral sensitivity among nursing students.
Cisplatin-induced ototoxicity (CIO) is a serious and underrecognized side effect of chemotherapy that, for various reasons, is often overlooked or omitted from focused care discussions between oncology providers and patients.
The Impostor Phenomenon Syndrome (IPS) is characterized by persistent self-doubt and fear of being exposed as intellectually fraudulent despite objective evidence of competence. Increasing evidence suggests that IP is common among health professions students, and demanding academic environments, together with early clinical exposure, have been associated with greater psychological distress. This study examined the severity of impostor phenomenon among undergraduate nursing and allied health students at Shahid Sadoughi University of Medical Sciences, Yazd, Iran. This cross-sectional study was conducted in 2025 among 300 undergraduate students enrolled in Nursing, Midwifery, Operating Room Technology, Anesthesia Technology, and Medical Laboratory Sciences who had completed at least one clinical internship. These disciplines represent four-year undergraduate allied health degree programs. Participants were selected using stratified random sampling according to academic discipline. Impostor phenomenon was measured using the 20-item Clance Impostor Phenomenon Scale (CIPS), which assesses three dimensions: Fear of being exposed as a fraud (8 items), Discounting achievements (9 items), and Attributing success to luck (3 items). The total CIPS score ranges from 20 to 100 and is categorized as follows: 40 ≤ Mild IPS, 41-60 Moderate IPS, 61-80 Severe IPS, 80 > Very severe IPS. Group comparisons were performed using independent-samples t tests, one-way ANOVA, or Mann-Whitney U tests, as appropriate. Associations between participant characteristics and impostor severity were explored using an ordinal logistic regression model. Statistical significance was set at p < 0.05. Based on the conventional CIPS severity categories, 48.7% of students (n = 146) were classified as having severe IP symptoms, whereas 36.3% (109) experienced moderate symptoms. Only 7.0% of participants (n = 21) were classified as having mild symptoms, while 8.0% were categorized as having very severe symptoms (n = 24). The mean total CIPS score was 62.43 ± 14.06, placing the group means at the lower threshold of the severe symptom category. Among the CIPS dimensions, the highest mean score was observed for discounting achievements (28.26 ± 6.97), followed by fear of being exposed as a fraud (25.86 ± 5.69) and attributing success to luck (8.31 ± 2.81). Overall differences in impostor scores across disciplines were modest (p-value = 0.04), and analyses identified significant differences only for the attributing success to luck dimension (p-value = 0.01). Compared with Nursing students (reference category), Midwifery students (p = 0.004) and Anesthesia Technology students (p = 0.002) had significantly higher odds of belonging to higher impostor phenomenon severity categories. Operating Room Technology students showed a borderline association with higher severity (0.05), whereas no significant differences were observed for Medical Laboratory Sciences students compared with nursing (p > 0.05). Impostor phenomenon was highly prevalent among undergraduate nursing and allied health students, with the overall mean score falling within the severe range. Compared with Nursing students, those in Midwifery and Anesthesia Technology had significantly higher odds of experiencing more severe impostor phenomenon. However, the regression model explained only a small proportion of the variability, indicating that demographic and academic characteristics alone are insufficient to explain impostor experiences. These findings provide a foundation for future multicenter longitudinal and intervention studies to identify modifiable educational factors associated with impostor phenomenon and to evaluate strategies for reducing impostor-related distress during clinical training. None.
The Eat, Sleep, Console (ESC) model of care offers a patient-centered approach for managing neonatal opiate withdrawal syndrome (NOWS), reducing hospital stay, need for pharmacologic treatment, and costs compared to the traditional Finnegan scoring system. Favorable nursing knowledge, attitudes, and practices (KAP) are critical to successful ESC implementation. A prior pilot survey in our neonatal intensive care unit (NICU) revealed inconsistent understanding and application of ESC, indicating a need for targeted education. This study assesses changes in NICU nursing KAP scores following a three-month multiphase educational intervention, and identifies behavioral shifts, barriers, and opportunities to optimize ESC integration. We conducted a pre-post quasi-experimental study in a Level IV NICU using anonymous 11 point surveys completed by NICU nurses assessing knowledge, attitudes, and perceptions towards ESC before and after the collaborative educational intervention. The intervention included (1) a didactic session with open discussion, (2) an ESC poster displayed in the NICU, and (3) a one-page ESC reference guide. Statistical analyses utilized analysis of variance (ANOVA). Thirty-three NICU nurses completed the pre- and post-intervention surveys; samples were independent and unmatched with an unknown degree of overlap. The increase in mean total KAP scores from 14.8 ± 2.2 to 15.3 ± 2.5 was not statistically significant (p = 0.40). Nurses with less than five years of experience showed the greatest improvement in knowledge and total KAP scores, increasing from 6.3 ± 1.5 to 8.3 ± 1.0 and from 14.3 ± 3.4 to 16.5 ± 1.9, respectively. Perceived safety and effectiveness of ESC improved slightly post-intervention. Didactic attendance did not significantly influence KAP (p > 0.80). Reported barriers to ESC implementation included staff and workflow constraints, limited family presence and parental involvement, lack of interdisciplinary support and system-level resources, and subjectivity and limitations of ESC assessments. Nurses emphasized the importance of greater social and family support, followed by increased nursing education, provider education, and improved lactation support. Collaborative education was not associated with statistically significant changes in NICU nursing KAP scores related to the ESC approach for NAS and may be insufficient as a stand-alone measure. Additional system-level support strategies may be needed to support ESC implementation fidelity and facilitate favorable nursing perceptions and practices towards ESC. Additionally, minimizing barriers affecting families and staff through tailored interventions may promote feasibility of ESC practices, also leading to improved nursing KAP.
Accelerated population ageing has resulted in increasingly diverse and complex care needs among older people, posing a major challenge to healthcare systems worldwide. Nursing personnel represent a core workforce in the delivery of healthcare and nursing services for older people, and their geriatric nursing competence (GNC) is closely associated with the quality of care provided, care outcomes and older people's quality of life. Therefore, accurate assessment of GNC is essential for nursing education, workforce development and quality improvement. Although several instruments have been developed to assess GNC, no systematic review has yet comprehensively evaluated their measurement properties. This protocol is reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015 statement. A comprehensive search will be conducted from 1 October 2026 to 1 December 2026 in seven English-language databases and two Chinese-language databases to identify studies reporting the development or evaluation of instruments assessing geriatric nursing competence among nursing personnel. Two reviewers will independently perform study selection, data extraction and methodological quality appraisal. Any disagreements will be resolved through discussion or, if necessary, consultation with a third reviewer. The measurement properties of included instruments will be evaluated using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology. As this review will include only published or publicly available studies, ethical approval is not required. The findings will be submitted for publication in a peer-reviewed journal and presented at relevant academic conferences. CRD420261356885.
It is crucial to implement knowledge-based, high-quality palliative care for the increasing number of frail older people with multimorbidities in nursing homes. The manager's role in a successful implementation is often taken for granted despite scarce evidence. Therefore, the aim of this long-term follow-up study was to explore how managers experienced the implementation of palliative care in nursing homes after a multicentre educational intervention for staff. This Implementation of Knowledge-Based Palliative Care in Nursing Homes (KUPA) program consisted of workplace seminars, reflective activities, and practice-based tasks between seminars. The implementation was research-led before the participating managers took over its governance. This qualitative follow-up study considered semi-structured interviews with 22 managers responsible for implementing palliative care in 20 nursing homes in Sweden. The analysis was conducted using a reflexive thematic approach. Our findings are presented under three main themes: Navigating Organisational Barriers, Empowering the Action Plan, and Ripple Benefits of Education. The managers navigate organisational barriers by establishing stability, maintaining continuity and supporting staff members' knowledge development despite structural barriers and limited resources. Empowering the action plan meant supporting staff to maintain motivation and a positive attitude towards workplace change. Managers emphasised their responsibility for the continuation of implementation of palliative care. The ripple benefits of education, from the managers' perspective, include increased knowledge and use of holistic palliative care, a shared language, and a consensus on the meaning of palliative care, thereby expanding cooperation and mutual understanding across the team's professions. This long-term follow-up study revealed several challenges to the implementation of palliative care and underscored the demanding work of managers. Staff shortage, limited budget and support led to work-related instability. Closer interprofessional collaboration and a broader approach to palliative care as a process from early signs to the end of life need to continue and deepen to be knowledge-based nursing care. From a leadership perspective, a successful implementation requires a long-term commitment, financial resources, a supportive organisation, and manager competence. NCT02708498. Date of registration: 26 February 2016.
Chronic obstructive pulmonary disease (COPD) is one of the most common chronic conditions that requires effective management through medication adherence and improved health literacy. Tele-nursing, as a modern educational method, can play a significant role in enhancing these outcomes. This study aimed to investigate The Effect of Tele-nursing Education on Medication Adherence and Health Literacy in COPD patients. In this quasi-experimental study with a pre-test-post-test design, 70 patients with COPD who referred to teaching hospitals in Zahedan in 2024 were selected through convenience sampling and randomly assigned by coin toss into intervention and control groups (35 patients each). The intervention group used a researcher-developed mobile application called "Hamdam-e-Salamat" for one month. This app included educational videos, medication reminders, and the ability to record vital signs. Data collection tools included the Morisky Medication Adherence Questionnaire and the TOFHLA Health Literacy Questionnaire, which were completed by both groups before and one month after the intervention. Data were analyzed using SPSS version 27 with Chi-square, paired t-test, and independent t-test. The majority of patients were male. The mean age in the intervention group was 68.82 ± 6.88, and in the control group, 69.97 ± 4.23. The mean score of medication adherence before the intervention was 3.91 ± 1.63 in the intervention group and 3.74 ± 1.22 in the control group. After the intervention, this score changed to 1.11 ± 0.86 in the intervention group and 3.68 ± 1.25 in the control group. Tele-nursing education led to a 2-point reduction in medication nonadherence score in the intervention group, which was statistically significant compared to the control group (p < 0.001). Additionally, the mean health literacy score in the intervention group increased from 49.25 ± 4.97 before the intervention to 56.02 ± 4.94 after the intervention, which was statistically significant (p < 0.001), while this change in the control group was not significant (p = 0.37). Tele-nursing education can be an effective method for improving medication adherence and enhancing health literacy in patients with COPD. It is recommended that this educational approach be incorporated into care programs for patients with chronic illnesses.
Antimicrobial stewardship (AMS) is a systematic programme to optimise antimicrobial use and forms a key pillar of the strategies that are developed to address the global threat of antimicrobial resistance. Nurses constitute the highest number of healthcare professionals, and engagement of nursing is key to AMS. Intensive care units (ICUs) have a high-volume antimicrobial use, and yet nursing integration in AMS in the ICUs is undertheorised. Using constructivist grounded theory, we conducted 36 in-depth interviews with ICU clinicians in two Australian hospitals to explore the processes involved in navigating their roles in AMS. The resulting theory, metaphorised as 'Setting a bonfire in a newfound cave' mapped a phased process of integration reflecting the situated and variable ways nurses encounter, interpret and engage with AMS in practice. Beyond clinical insights, this study theorises AMS as jurisdictional project where nurses negotiate limits of expertise and authority, while navigating organisational and interprofessional challenges. Findings reframe AMS as a politics of care wherein players experience tensions between bureaucratic constraints and ethical obligations. The resulting theory specified the processes required to embed AMS into the core of nursing identity and practice. Situating the discretionary actions of nurses within logic and bureaucracy, we offer nuanced accounts and perspectives of how power, hierarchy and cultural norms influence and shape implementation of innovative strategies such as AMS. The theoretical insights of this study contribute to health sociology, ethics of care and implementation studies by illustrating how authority and transactions in AMS are negotiated, shared and redistributed in practice.
Clerkship students encounter ethically significant dilemmas but have limited opportunities to rehearse ethically grounded decision-making and difficult conversations in realistic clinical contexts. We evaluated an immersive, sequential simulation-based clinical ethics education program. We conducted an explanatory sequential mixed-methods pre-post study with clerkship students at Kaohsiung Medical University from September 1, 2022, to May 31, 2023. Participants completed a core e-learning curriculum (digital modules/videos) before a two-day immersive simulation. The simulation comprised six longitudinal standardized patient cases, each with four sequential scenarios. Quantitative outcomes included ethical knowledge, ethical sensitivity, vignette-based ethical decision-making, and confidence in managing clinical ethical dilemmas; satisfaction was measured post-intervention. Pre-post comparisons were made using Wilcoxon signed-rank tests. Focus groups were audio-recorded, transcribed verbatim, and analyzed using reflexive thematic analysis. Findings were integrated using a joint display. Thirty-eight clerkship students participated. Post-intervention ethical knowledge showed gains across all seven assessed domains. Ethical sensitivity increased across three issues, and ethical decision-making improved across all six vignettes. Confidence increased in nine of 11 items, including dilemma awareness, clarifying ethical problems, ethical reasoning, communication to reach consensus, and confidence in ethical decision-making. Satisfaction with simulation education was high. Qualitative integration identified three themes explaining these gains: confidence through enactment, structured ethical decision-making, and voice and consensus under pressure. The program was associated with short-term gains in ethics knowledge, ethical sensitivity, vignette-based decision-making, and confidence. Qualitative findings suggested that enactment, feedback, and reflection made ethics learning more practical and increased learners' perceived readiness for challenging clinical encounters. Sequential simulation may help clerkship students connect principle-based ethics teaching with real-time reasoning and communication demands. Controlled longitudinal studies are needed to examine durability, transfer, and workplace-based performance. ClinicalTrials.gov identifier: NCT05547893.
Nursing care models that incorporate a skill mix, including care assistants, are increasingly introduced in intensive care units (ICUs) to address workforce challenges. Understanding staff experiences with the early implementation of such models is essential to support effective collaboration and safe care delivery. This study aimed to explore the ICU nurses' and care assistants' experiences with a newly implemented skill mix, focusing on collaboration, role allocation, and perceptions of care delivery. An exploratory qualitative study was conducted using four focus group meetings with 33 ICU nurses and nine care assistants working in two adult ICUs of a large tertiary hospital in the Netherlands (August to December 2023). Data were audiotape-recorded, transcribed verbatim, independently coded by two researchers, and analysed using thematic content analysis. Three major themes were identified: (1) Navigating change and adopting roles, including clear and continuous communication, realistic expectations, and guidance through team managers; (2) Collaboration and team dynamics, encompassing team spirit, recognition to bridge a knowledge gap, opportunities for professional growth, and added value in essential care; (3) Balancing responsibilities in delivering safe care, highlighting tensions related to task allocation and accountability during early implementation. The findings of this early phase evaluation illustrate tensions experienced by ICU nurses and care assistants when adapting to new role distributions within a nursing care model including skill mix. Clear and continuous communication, aligned expectations, and practical support tools-such as guidelines or task cards-facilitate collaboration and support ICU teams during the implementation of such models. Not applicable.
The Jordanian emergency nurses are now the victims of cruel behaviors such as violence. The incident of Workplace Violence (WPV) is increasing annually with a growing impact on the continuity of the treatment process and nursing work. The purpose of this study was to identify the types of WPV against nurses in emergency departments EDs and identify the contributing factors. Also, it establishes the variations in WPV exposure among ED nurses based on the geographical location of hospitals (North, Middle, and South). A descriptive cross-sectional, comparative design was conducted with a convenience sample of 200 emergency nurses. Data were collected via the Arabic version of the WHO workplace violence questionnaire. Bivariate associations were examined using Chi-square, Mann-Whitney U, and Kruskal-Wallis tests, with Cramer's V for effect sizes. Binary Logistic Regression was executed to identify independent predictors of violence exposure (P ≤ 0.05). Overall, 73.5% of emergency nurses experienced workplace violence; 70% faced non-physical violence and 27% experienced physical violence. Bivariate analysis showed male nurses were significantly more exposed to physical violence than females (p = 0.024). Binary logistic regression revealed that female gender significantly predicted lower odds of physical violence (OR = 0.42,95% C.I.[0.21, 0.83], p = 0.01). Significant geographical variations were found for both physical (x² = 6.112, p = 0.047) and non-physical violence(x² = 15.755, p = 0.001), with the Middle region exhibiting the highest exposure rates. Working in the Southern region significantly predicted lower odds of non-physical violence (OR = 0.56, 95% C.I.[0.37, 0.87], p = 0.01). Workplace violence is highly prevalent among Jordanian emergency nurses, significantly disrupting the continuity of the treatment process and compromising nursing work environments. Aligned with the study's aim, the findings highlight that hospital overcrowding and regional density-particularly in the Middle region-escalate violence exposure. Urgent administrative interventions, such as extending outpatient clinic hours and strengthening security enforcement, are vital to safeguard emergency staff and optimize healthcare delivery.
Research has established the accuracy and reliability of emergency nursing triage. However, little is known about how emergency nurses use assigned triage scores to determine the order of emergency bed assignments. We define acuity-arrival order as the prioritization of patients first by acuity and then by time of arrival. An observational study was conducted across 6 emergency departments. Participants were emergency nurses in roles responsible for determining emergency bed assignments. Data were collected using demographic questionnaires, a structured data collection tool, and narrative field notes. Analysis included inductive content analysis and descriptive statistics. Overall, 18 observation sessions were completed, including 37 nurse participants. Among 524 patient encounters, 325 bed assignment decisions were observed, of which 57.8% deviated from acuity-arrival order. Prioritization decisions were shaped by variable institutional norms and processes. In small departments, triage scoring was completed inconsistently and did not play a significant role in determining bed assignment order. In large departments, patient prioritization was heavily impacted by the presence of patient streaming processes. Across all study sites, nurses expressed distrust in assigned triage scores and the belief that patient prioritization is a complex and holistic decision. Waiting emergency patients do not systematically receive bed assignments according to their assigned triage score or wait time. Instead, patient prioritization is determined through complex considerations of clinical acuity, waiting room safety, patient flow management logistics, and operational expectations. Patient prioritization has been found to be subjective and inconsistent, raising concerns about the quality, safety, and ethics of current emergency practice.
Cancer patients in the Gaza Strip have long faced major barriers to timely diagnosis, treatment, and continuity of care. These barriers have become substantially more severe under war conditions, displacement, and the collapse of health services. This study aimed to explore the experiences of adults with cancer in the Gaza Strip before and during war, with a particular focus on access to healthcare, support mechanisms, and basic living conditions. This qualitative study was conducted with 12 adults diagnosed with cancer and living in shelters, displacement centres, or tents in the Gaza Strip. Data were collected through in-depth semi-structured interviews in Arabic and analysed using content analysis. The analysis identified six key themes describing cancer care in the Gaza Strip, organized within two temporal categories: three themes characterized the pre-war period and three themes characterized the wartime period. The pre-war themes were problems in access to healthcare services, support mechanisms, and positive aspects related to diagnosis and treatment. The wartime themes were problems in access to healthcare services, insufficiency of support mechanisms, and inadequacy of basic living conditions. Participants reported that even before the war, they experienced delayed diagnosis, fragmented treatment pathways, financial hardship, and limited psychosocial support, although some described positive experiences with functioning hospitals and treatment availability. During the war, participants described severe disruption of medical follow-up, hospital inaccessibility, medication shortages, inability to travel for treatment, irregular or insufficient support, displacement, food insecurity, and worsening physical and psychological burden. The findings show that cancer care in the Gaza Strip was already fragile before the war and became profoundly disrupted during it. The experiences of patients highlight the need for integrated responses that address not only treatment continuity, but also psychosocial support, nutrition, and basic survival needs. The study also underscores the interdisciplinary relevance of cancer care in conflict settings for medicine, nursing, and social work. By showing how treatment uncertainty, disrupted support, and unmet survival needs interact, the study identifies patient-level psycho-oncological priorities for cancer care in conflict and crisis settings.
This study aimed to translate and culturally adapt the Medical Artificial Intelligence Readiness Scale for Medical Students into Korean and to examine its validity and reliability among nursing students. The scale designed in this methodological and cross-sectional study was translated and adapted using standard procedures and validated with 317 nursing students in South Korea. Experts reviewed the content validity. Structural validity was examined through exploratory and confirmatory factor analyses. Construct validity was evaluated through hypothesis testing using an external criterion measure. Reliability was evaluated using Cronbach's alpha and the split-half method. The final Korean version of the Medical Artificial Intelligence Readiness Scale (K-MAIRS) comprised 15 items across four factors-cognition, ability, vision, and ethics-explaining 66.88% of the variance. The K-MAIRS can be a valid and reliable instrument for assessing artificial intelligence readiness among Korean nursing students. This instrument supports global initiatives to incorporate artificial intelligence competencies into nursing education using culturally tailored assessment tools. It also supports educators and institutions in designing targeted strategies for artificial intelligence education within nursing curricula that enhance nurses' preparedness in artificial intelligence-driven healthcare environments.
Background  Foodborne illnesses remain a major global public health concern, often linked to poor hygiene and unsafe food handling. Dormitory students are particularly vulnerable due to shared kitchen facilities and varying levels of food safety awareness. This study aims to assess knowledge, attitudes, and practices (KAPs) regarding food safety among dormitory students at the University of Sharjah. Materials and methods  A cross-sectional study was conducted at the University of Sharjah during 2024-2025. The sample was selected using convenience sampling, targeting at least 385 students. A self-administered questionnaire adapted from validated studies was distributed among university dormitories. It included demographic data, multiple-choice questions (MCQs) assessing knowledge and practices, and a Likert-scale section assessing attitudes toward food safety. Data were analyzed using SPSS version 29. The chi-square test was used to assess the association between categorical variables, with statistical significance set at p < 0.05. Results  A total of 399 dormitory students participated. Of these, 249 (62.4%) were female. Most students were aged 20 years or older. A total of 238 (59.6%) were enrolled in medical-related majors. The sample included students from women's dormitories (150, 37.6%), men's dormitories (150, 37.6%), and medical/nursing dormitories (99, 24.8%). Age and gender were significantly associated with practice level (p = 0.048 and p < 0.001, respectively), with students aged ≥20 years and female students demonstrating better practices. More than half of the medicine and health sciences students had good knowledge (130, 54.6%) compared with non-medical students (p = 0.004). Students in the medical/nursing dormitory reported higher levels of good knowledge (63, 63.6%) and good practice (55, 55.6%) (p = 0.001 and p < 0.001, respectively). Higher knowledge was associated with better attitudes and better practices, and a higher attitude level was associated with a better practice level. Conclusions Dormitory students at the University of Sharjah demonstrated poor attitudes and moderate levels of food safety knowledge and practices. The observed knowledge-attitude gap represents a public health concern. Universities should implement targeted educational interventions to improve food safety awareness and promote the translation of knowledge into appropriate attitudes and practices.
IntroductionJuvenile Huntington's disease (JHD) is a rare, severe neurodegenerative disorder with early onset, high symptom burden, and a predictable trajectory toward advanced disability and premature death. Despite this, goals-of-care (GOC) conversations and advance care planning are often delayed, leading to reactive, crisis-driven decisions and increased emotional burden for families and clinicians.Case PresentationWe present a 30-year-old woman with genetically confirmed JHD, diagnosed at age 14, who declined progressively over more than 15 years. Despite longstanding neurological follow-up and repeated hospital admissions, palliative care referral occurred only 20 days before death. At evaluation she had complete dependence, profound cognitive impairment, severe dystonia, advanced dysphagia with gastrostomy, and recurrent aspiration. The absence of prior GOC discussions created uncertainty regarding hospital transfer, antibiotics, artificial nutrition and hydration, and palliative sedation. After retrospective review, interdisciplinary discussion, family meetings, and ethics consultation, the palliative care team established a comfort-focused plan that avoided further transfers, limited nonbeneficial interventions, and prioritized symptom control. Subcutaneous opioids, benzodiazepines, and anticholinergics relieved distress, rigidity, and secretions. The patient remained in the nursing facility until death.DiscussionLate palliative care integration limited anticipatory planning and shifted complex decisions into a stage with little room for deliberation, when cognitive and clinical deterioration constrained meaningful participation.ConclusionsJHD offers a useful model for early palliative care integration. Earlier outpatient referral and closer neurology-palliative care collaboration may enable longitudinal GOC conversations, anticipate complex decisions, and reduce the clinical, emotional, and ethical burden of advanced disease.
This study aims to build a rural Appalachian cohort to examine how US Food and Drug Administration (FDA) Center for Tobacco Products (CTP) regulatory policies influence tobacco and nicotine product use across levels of rurality. The AppalTRUST (Appalachian Tobacco Regulatory Science Team) Cohort integrates four inter-connected Community-engaged Research + Technology (CEnRT) elements to support recruitment and retention: (1) building trust and cultural relevance; (2) addressing barriers to participation in research; (3) focusing on ethics and confidentiality; and (4) fostering ongoing and consistent collaboration between the scientific and field teams. The study uses a dual sampling design to recruit 1,000 quota-based non-probability sample participants and 1,000 address-based probability sample participants. Eligible adults (ages 18+) are recruited from two Appalachian Kentucky catchments spanning rural and peri-urban counties. A local field team combines culturally relevant engagement strategies with technology-enabled procedures, including virtual consent and participant tracking, to foster trust and relevance with an underserved population. Recruitment is ongoing. Feasibility indicators include enrollment of 985 non-probability sample participants and 209 probability sample participants, a 16% direct-mail response rate, and a 62% participant preference for text-based consent and survey reminders. Expected outcomes include guidance for applying CEnRT approaches in underserved populations, characterization of tobacco and nicotine use trends across the rural-peri-urban continuum, and description of marketing exposure and consumer choice among subgroups of young adults and daily users in Appalachia. Findings will inform FDA CTP regulatory decision-making in rural Appalachian communities. This integrated CEnRT approach shows promise for recruiting and retaining rural Appalachian adults by centering community voice, trust, confidentiality, and practical engagement strategies.
Endotracheal tube (ETT) suctioning is a critical nursing procedure essential for airway management in mechanically ventilated patients admitted to intensive care units (ICUs). Proper suctioning practices help reduce complications, including ventilator-associated pneumonia (VAP). However, evidence suggests that ICU nurses' knowledge and practices regarding ETT suctioning remain suboptimal. This study aimed to assess the effectiveness of an educational intervention on ICU nurses' knowledge and practices regarding ETT suctioning. A quasi-experimental single-group pretest-posttest study was conducted in the intensive care units (ICUs) of three public sector tertiary care hospitals in Peshawar, Pakistan. Eligible ICU nurses who met the inclusion criteria and consented to participate were recruited using convenience sampling (n = 60). Knowledge and practice were assessed before and after the educational intervention using a structured knowledge questionnaire and an observational practice checklist. Nurses' knowledge scores improved significantly following the intervention (pre-intervention: 6.57 ± 1.79 vs. post-intervention: 10.23 ± 1.68; mean difference = 3.66; p < 0.001), with a very large effect size (Cohen's d = 2.12). Practice scores also increased significantly from 12.65 ± 1.83 to 16.38 ± 1.43 (mean difference = 3.73; p < 0.001), corresponding to a very large effect size (Cohen's d = 2.27). The educational intervention was associated with substantial improvements in ICU nurses' knowledge and practices regarding endotracheal suctioning. However, because this study employed a single-group pretest-posttest design without a control group, the findings should be interpreted with caution, as causal relationships cannot be established. Regular in-service education is recommended to maintain competency and promote adherence to evidence-based endotracheal suctioning practices. Not applicable.