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Rapid population aging has heightened the need for efficient integrated medical and older adult care services in China. Despite policy-driven expansion since 2013, the static efficiency and dynamic productivity performance of integrated medical and older adult care institutions have not been well characterized. This study adopts the Malmquist production index method under the data envelopment analysis (DEA) approach to dynamically assess the total factor productivity (TFP) of 54 integrated medical and older adult care institutions in six provinces (Hebei, Inner Mongolia, Jilin, Shandong, Hubei, and Sichuan) across the eastern, central, and western regions of China from 2020 to 2022 and to analyze the current status and development trends of their productivity. The Malmquist index results showed that total factor productivity increased from 2020 to 2021, with a TFP index of 1.118, but declined from 2021 to 2022, with a TFP index of 0.956, indicating short-term fluctuations in dynamic productivity. These results suggest that the productivity changes of integrated medical and older adult care institutions were not stable across the study period. In terms of regional differences, the comprehensive efficiency and pure technical efficiency in the eastern region are greater than those in the central and western regions. This result may be closely related to differences in economic development, policy support, and the distribution of health care resources. In addition, although some institutions show higher efficiency at the technical level, their comprehensive efficiency fails to reach the optimal level because of irrational scale allocation. Improving the total factor productivity of integrated medical and older adult care institutions is a complex systematic task that not only relies on technological progress but also requires the optimization of resource allocation and scale management.

The development and integration of geriatric medicine into national health care systems vary widely across countries. While a robust care workforce requires providers from several disciplines, including nursing, social sector, rehabilitation, psychiatry, neurology, and others, a strong core of highly qualified geriatricians is essential to delivering older person-centred and integrated care. The number and professional profile of geriatricians, along with the status of the specialty, are important to informing efforts to reshape health care systems in response to the global ageing scenario. WHO developed and distributed a structured questionnaire to representatives of national geriatrics and gerontology societies beginning in March 2025. The survey collected data on the status of the geriatric medicine specialty, including its formal recognition at the country level, the estimated number of practising geriatricians, and information on training curricula, professional environments, and systemic challenges. A total of 48 national societies completed the survey. Recognition of geriatric medicine ranged widely, from full specialty status in some countries to subspecialty or non-recognition in others. The number of practicing geriatricians per 100,000 persons aged 60 years and older ranged from <0.1 to >30 across countries, illustrating marked workforce disparities and some severe shortages. Where the geriatric medicine specialty is formally available, pre-service training durations ranged from 24 to 96 months. Geriatricians worked in diverse settings, though integration into primary care and public health was limited. Training in and exposure to geriatric medicine principles during undergraduate and postgraduate medical training were minimal in many countries. Key challenges included workforce shortages, fragmentation of care, and undervaluation of the speciality's role in informing health care for older people. Strategic priorities reported by respondents included investment in training, policy development, and institutional support. The survey highlights disparities in geriatric medicine across countries and identifies several challenges and priorities. Strengthening education, policy, and workforce development is essential to meet the needs of ageing populations and support healthy ageing worldwide. At the same time, countries should also think of innovative approaches and building capacity of existing other health occupations to improve geriatric care. Future updates of this survey will provide longitudinal insights into workforce evolution. These findings provide a global evidence base to guide workforce planning and policy under the United Nations Decade of Healthy Ageing (2021-2030).

To explore what nurses value in their practice that helps to inform nurse satisfaction. Nurse turnover is a growing concern, with nurses leaving the profession in unprecedented numbers. What nurses value in their practice has evolved over the past decade; understanding these shifts is important to strategize the future of nursing practice. Qualitative, descriptive study using focus groups to explore inpatient acute care nursing values. Participants (n=52) identified 4 interrelated themes: relationship building with patients, colleagues and leaders; the importance of compassion, patient advocacy, and a team approach to care; barriers to care, including resource constraints, communication issues, and role strain; and perspectives on the future of nursing. Nurses remain optimistic about their ability to adapt to innovative advances, role expansion, and maintaining the human-to-human connection that is foundational to nursing practice. The findings offer important insights into what nurses value and are challenged by, which may guide future nursing research, strategies for leaders, organizational improvement and nurse retention.

Group antenatal care (G-ANC), integrating medical care with education, has demonstrated positive effects on maternal and newborn health. Individual studies have shown promising evidence in sub-Saharan Africa, but systematically synthesising the existing research would facilitate implementation and identify gaps for further research. This systematic review aimed, therefore, to review the existing evidence on feasibility, acceptability and effectiveness of G-ANC in resource-limited settings to guide policy and support implementing G-ANC to reduce maternal and perinatal mortality. A systematic and comprehensive literature search was conducted in the PubMed/MEDLINE, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Excerpta Medica Database (Embase) and Google Scholar electronic databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews and meta-analyses of healthcare interventions were followed. Data were extracted using a prespecified protocol and quality was assessed using the Joanna Briggs Institute appraisal tool. Random-effects meta-analyses were used to pool estimates. The review is registered on the International Prospective Register of Systematic Reviews (PROSPERO: CRD42024565501). Of the 576 articles identified, 34 articles with 42&#x2009;234 participants were included. G-ANC increased the likelihood of attending four or more ANC visits (pooled risk ratio (RR)=1.45; 95%&#x2009;CI 1.22 to 2.82), was associated with the likelihood of attending postnatal care visits (RR=1.23; 95%&#x2009;CI 1.03 to 1.47), increased uptake of postpartum family planning methods (RR=1.85; 95%&#x2009;CI 1.26 to 2.73) and was associated with improved birth weight (RR=1.53; 95%&#x2009;CI 1.09 to 2.14). It was also associated with improved quality of care, health literacy, psychosocial gains, empowerment and facilitating culturally sensitive discussions. There was, however, no significant difference found between groups regarding likelihood of giving birth at health facilities compared with the traditional ANC. Also, no cost-effectiveness studies of G-ANC were identified in sub-Saharan Africa, highlighting a key evidence gap for guiding future implementation and scale-up. Exposure to G-ANC enhances utilisation of maternal healthcare such as ANC attendance, postnatal care, family planning uptake and improves birth weight. It also improves maternal engagement, health literacy and empowerment through a highly participatory learning approach and peer support. Nevertheless, no notable difference was observed between the groups in terms of likelihood of giving birth in health facilities. CRD42024565501.

This paper reports findings from a qualitative descriptive study exploring the potential use of service robots in nursing homes. Participants in three workshops expressed optimism and creativity regarding the role of robots in supporting a variety of tasks, including housekeeping, transportation, monitoring, and entertainment. These findings align with previous research that identified similar task areas suitable for robots in nursing homes. Despite growing interest, the integration of robotics into elderly care remains limited due to technical, ethical, and organizational challenges. Many solutions remain in pilot stages, hindered by costs, lack of training, and safety concerns. Resistance to change, worries about reduced human contact, and unclear role definitions further slow adoption. Moreover, the absence of clear regulations and interoperability standards complicates large-scale implementation. Future research should focus on strategies that incorporate end-users' perspectives throughout the development and testing of service robots, thereby identify potential areas for increased use of service robots in nursing homes.

Children's exposure to sexually explicit online material has been associated with early sexualisation, distorted gender norms, risky sexual behaviours, and adverse mental health outcomes, with first exposure often occurring before the age of 12 and increasingly through mainstream digital platforms. Age assurance has therefore emerged as a regulatory approach that shifts the responsibility of restricting underage access from parents to digital services. The United Kingdom Online Safety Act 2023 establishes one of the first comprehensive statutory age assurance frameworks, combining risk-based duties, regulatory guidance, multiple verification pathways, privacy protections, and staged enforcement. This study applies a desk-based policy analysis, guided by the Health Policy Triangle, to examine the regulatory architecture of the United Kingdom age assurance framework and assess the conditional transferability of its safeguards to sub-Saharan Africa. The sources included legislation, regulatory guidance, official policy documents, civil society analyses, peer-reviewed literature, and early implementation reports published between 2020 and 2025. Early implementation signals indicate platform compliance actions, reported traffic reductions to certain adult sites, increased circumvention behaviour, including the use of virtual private networks, and mixed public responses characterised by broad support for child protection alongside concerns about the effectiveness of the measures and the sharing of identity credentials. These indicators are interpreted as preliminary governance and implementation signals rather than the evidence of policy effectiveness. Five policy design elements appear potentially adaptable under equity and capacity constraints: risk-based proportionality, multiple and document-free verification pathways, transparency and vendor accountability, staged supervision and enforcement, and cross-regulator coordination. The study provides a policy analytic framework for country-level adaptation in sub-Saharan Africa and highlights priorities for context-sensitive implementation and future evaluation.

Snakebite envenomation remains a critical health challenge across the culturally and ecologically diverse sub-Saharan Africa (SSA). This study examined healthcare providers' (HCPs') knowledge, attitudes, and practices (KAP), and their determinants towards snakebite envenomation. A cross-sectional study was conducted across nine SSA countries using the validated Knowledge, Attitudes, and Practices of Snake Envenomation - Healthcare Providers Questionnaire (KAPSE-HCPQ). The fractional logistic regression was conducted to identify the factors associated with KAP. A total of 3,544 HCPs were enrolled through professional and digital networks. General practitioners represented approximately half of the participants (50.1%), whereas toxicologists were 3.2%. Considerable variations were reported across sub-Saharan countries. Uganda and Sierra Leone attained perfect median knowledge scores (100%, range: 93-100, 73-100, respectively) yet both demonstrated marked deficiencies in practice (range: 0-25% and 0-75%, respectively). Attitude scores ranged from the lowest in Ethiopia (79%, range: 75-85%) to the highest in Uganda (91%, range: 87-95%). Higher knowledge was significantly associated with advanced training, antivenom availability, curricular inclusion of toxicology, and self-study. Positive attitudes were significantly associated with prior clinical exposure, faculty-based education, informal information sources, and participants' countries. HCPs demonstrated incorrect practices, such as applying a tourniquet above the bite site, attempting to suck out the venom, incising the bite wound, and asking to run to the nearest health facility, which may accelerate the systemic venom spread. In contrast, pharmacists and HCPs unaware of management guidelines demonstrated poorer practices. The study identifies a substantial gap between theoretical knowledge and clinical practice among HCPs across SSA, with variations by country, profession, training, and resource availability. Urgent interventions training, protocol standardization, and reliable antivenom supply are required to improve snakebite outcomes. Although healthcare providers across sub-Saharan Africa generally have good knowledge and favorable attitudes towards snakebite management, their actual practices remain persistently inadequate, irrespective of their country&#x2019;s income level.Systemic barriers - limited formal training, absent institutional protocols, unreliable antivenom supply, and weak referral systems- are highly associated with inadequate clinical practice.Urgent standardization of training protocols and reliable antivenom supply are needed to improve snakebite outcomes across the SSA region.

To explore the medium-term to long-term implementation and outcomes of the Nursing Research Challenge (NRC) in a Magnet&#xae; designated university hospital. Research-driven culture advances nursing practice, yet structured, impactful initiatives in European hospitals are scarce. A longitudinal study (2023-2025) in a private Magnet&#xae; tertiary hospital applied the Joanna Briggs Institute framework and RE-AIM model. Research capacity was assessed at T0, T1, and T2 using the validated Nursing Research Questionnaire. Of 515 nurses completing the Nursing Research Questionnaire (T0=116; T1=127; T2=272), significant gains occurred in knowledge (+1.48) and resource use (+0.83) (P<0.001). Research use in decision-making and scholarly activity increased; attitudes improved modestly. Satisfaction was high (4.6/5). Nurses with master's/doctoral degrees rose from 38% to 54%. The NRC enhanced research capacity and engagement. Success factors were baseline assessment, strategic alignment, leadership, and infrastructure. The scalable model supports global adoption of a research-oriented nursing culture.

The shortage of coordinating physicians in French nursing homes raises concerns about care organization and task distribution. The integration of advanced practice nurses (APNs) is a possible approach that remains underexplored in this setting. Objective. To explore healthcare professionals' perceptions of the APN role in nursing homes and to identify tasks that could potentially be shared with coordinating physicians. A multicenter descriptive study was conducted in the Val-d'Oise department (France) between November 2024 and February 2025. Three self-administered questionnaires were distributed to coordinating physicians, coordinating nurses, and nursing home directors. The analysis combined descriptive and comparative approaches, including a cross-analysis of perceived delegation and reported practices. A total of 131 professionals from 75 facilities participated. Several tasks were identified as potentially shareable, including geriatric assessment, care coordination, staff training, and risk management. Medication prescribing was largely perceived as non-delegable. Differences in perception were observed between professional groups, with coordinating nurses generally more supportive of expanded APN roles than physicians, consistent with observed differences in practice patterns. This study shows a gradient in the acceptability of task sharing with APNs, depending on the type of task. It identifies clinical and organizational areas where roles could evolve. Experience from other countries suggests that structured task-sharing models can improve care coordination and access to care. These findings support the need for pilot studies to assess the integration of APNs in French nursing homes.

In this column, Laura J. Wood, DNP, RN, NEA&#x2011;BC, FAAN, Executive Vice President, Patient Care Operations, System Chief Nurse Executive, and Sporing Carpenter Chair for Nursing at Boston Children's Hospital, shares the leadership philosophies and structural decisions that have enabled innovative clinical practice and workforce stability in one of the nation's most complex pediatric health systems. As President of the American Nurses Credentialing Center (ANCC), Dr Wood brings a national perspective on professional development, certification, and the future of nursing leadership. Her insights reflect a consistent belief: stability, excellence, and well&#x2011;being are not accidental, but the result of intentional thought leadership and planning.

To explore organisational opportunities for person-centred care in residential aged care facilities from the perspectives of managers and staff. A qualitative study using focus group discussions and inductive thematic analysis followed by a deductive interpretation guided by a theoretical framework. Residential aged care facilities providing long-term care for older people in Sweden. A total of 23 participants were recruited using purposive sampling and participated in five focus groups. Participants included assistant nurses, occupational therapists, physiotherapists, registered nurses, social service managers and healthcare managers working in residential aged care. To be included, participants had to have experience of working in residential aged care. The analysis generated two interconnected themes. The inductively developed theme, Creating foundations for person-centred care, described organisational conditions perceived as necessary for enabling person-centred care in residential aged care. Three subthemes highlighted the importance of establishing a safe and supportive environment, maintaining continuity of care and ensuring responsiveness to older persons' desires and needs. The deductively developed theme, Turning foundations for person-centred care into action, interpreted these organisational foundations in relation to the three routines of the University of Gothenburg Centre for Person-Centred Care framework: initiating, working and safeguarding the partnership. Partnership was understood as a way in which organisational foundations could be enacted in everyday care, rather than as a separate inductive finding. Person-centred care in residential aged care was described to require organisational conditions that support safe and supportive environments, continuity of care and responsiveness to older persons' preferences and needs. The findings suggest that workforce stability, managerial support, clear responsibilities, communication and active use of documentation are important for enabling person-centred care in everyday practice. Future initiatives should focus on developing and evaluating organisational approaches that support person-centred care in collaboration with older persons, relatives and staff.

In this column, leaders from ALSN discuss the issues presented by a lack of differentiation in functional nursing leadership competencies between Masters of Science in Nursing (MSN) and Doctorate of Nursing Practice (DNP) prepared graduates. An ad hoc committee of members of ALSN) was convened to conduct a comprehensive review of the existing literature and develop an initial set of nursing leadership competency and sub-competency statements that align with the AACN's Essentials 10 Domains of competency for nursing education.

Nurse executives face expanding responsibilities that include financial management, strategic planning, and system-level decision-making, yet many lack formal preparation in business competencies. This article examines the gap between expectations for executive roles and traditional academic preparation. It also explores the potential of the dual Doctor of Nursing Practice/Master of Business Administration pathway to strengthen leadership readiness. National stakeholder data demonstrate strong support among chief executive officers, chief nursing officers, and graduate nursing faculty for integrating business education into advanced nursing programs. Although the American Organization for Nursing Leadership identifies business skills as a core competency, variability persists in their integration across curricula. The Doctor of Nursing Practice/Master of Business Administration provides an integrated approach combining clinical expertise with financial and strategic business knowledge. As healthcare systems increasingly emphasize financial performance and value, organizations and academic programs must align leadership preparation with evolving executive expectations.

The American Organization for Nursing Leadership (AONL) convened a dialogue among a group of chief nursing officer (CNO)-chief financial officer (CFO) dyads, with support from the Healthcare Financial Management Association. An AONL subcommittee used the dialogue results to develop guiding principles to assist leaders in creating and strengthening CNO-CFO partnerships. This work suggests that leaders can approach the CNO-CFO relationship as strategic rather than transactional. As nurse executives strengthen leadership competencies, they can build trust, engage finance partners early, create shared measures of success, and align nursing priorities with enterprise value.

A single leadership decision, saying yes to a new way of honoring nurses, helped catalyze a global movement in nurse recognition. In 2000, Susan Grant, Chief Nursing Officer at the University of Washington Medical Center, agreed to pilot a program that invited patients and families to define extraordinary nursing care through their own stories. That decision became the DAISY Award&#xae;. In this interview, Dr Grant reflects on the origins of DAISY and leadership lessons for today. The message is clear: some of the most enduring innovations in nursing do not begin with metrics or technology, but with courage, humility, and a commitment to purpose.

To synthesize the literature on the influence of virtual nursing (VN) on patient, nurse, and system-level outcomes in acute care. Persistent nursing workforce challenges, including staff shortages and turnover, have been intensified by the COVID-19 pandemic, rising patient acuity, and increasing documentation demands. Many health systems have adopted VN programs, where remote nurses support bedside staff using audiovisual technology. Although these programs are rapidly expanding, evidence of their effectiveness remains limited. These authors conducted a scoping review following PRISMA guidelines. Eleven studies reporting patient, nurse, or system-level outcomes were included. Most studies were cross-sectional pilots. Evidence was strongest for nurse and patient satisfaction, with reports of improved discharge efficiency, reduced administrative burden, and higher patient satisfaction. Findings for other outcomes, including safety indicators and financial metrics, were inconsistently reported. Virtual nursing shows promise for enhancing patient satisfaction and workflow efficiency, but cannot replace investments in sufficient bedside staff and resources.

With a growing older population, there is an increased need for aged care services. Care staff are a critical factor in delivering these services. The aim of this study was to identify the key components of a well-being program for staff caring for older people with responsive behaviours in rural aged care homes. A single co-design session based on the seven integrated principles of World Caf&#xe9; was hosted. Facility staff, organisational representatives and consumers were identified through purposive and snowball sampling. Facilitators led scenario-based discussion on three topics: leadership, peer support and workplace practices. The academic literature synthesis conducted by researchers of the key components generated through co-design identified those with evidence of benefit and local feasibility. Twelve participants attended the co-design session. Key components identified were early 'check-ins' by management, ad hoc peer debriefing, regular scheduled whole-of-facility debriefing, peer-based rewards, conveying behaviour expectations, greater information on care recipients, fun workplace activities, team building and staff training. Two meso-level components considered feasible to implement and evidence-informed were: a peer supporter program and a structured all-of-facility debriefing. A co-design process involving consumers and staff identified two evidence-informed and feasible components of a well-being program for rural aged care staff: peer support and a structured all-of-facility debriefing. This process, blending co-design and evidence, has laid the foundation for a well-being program that could achieve sustained, positive change.

The evolution of nursing practice demands more than recognition of excellence. It requires practice environments that actively cultivate clinical nurses' professional voice, autonomy, and shared leadership. Empowering nurses to lead and own their professional practice contributes to optimal outcomes for both the patients and healthcare organizations. Moving Magnet recognition from traditional models of designation to transformation grounded in clinical nurses' autonomy for professional excellence is necessary. To achieve this change, it is necessary to shift from compliance to commitment, burnout to meaningful engagement, and hierarchy to shared leadership. Such a contemporary view then demonstrates the enduring value of Magnet recognition.

As the global population ages, especially in low- and middle-income countries, there is an urgent need to rethink how health in older age is understood and addressed. Frailty has long served as a clinical construct to identify vulnerability and guide tailored, specialist care for older people. In 2015, the World Health Organisation introduced the concept of intrinsic capacity (IC) as part of its healthy ageing framework, offering a structured, capacity-based approach to promote functional ability. While conceptually distinct, frailty and IC are complementary. Frailty highlights the need for specialised care in complex cases, whereas IC supports early intervention and prevention across broader populations. This paper explores their differences, areas of overlap and how their integration can support a continuum of care that spans primary to specialist settings. Integrating these concepts connects prevention, health promotion and complex care management. By aligning clinical and public health perspectives, the combined use of frailty and IC offers a holistic, person-centred approach to care system transformation, with the potential to drive coordinated strategies that strengthen both geriatric practice and public health across diverse populations.