To describe the overall level of self-assessed Traditional Chinese Medicine (TCM) nursing competency among clinical nurses, identify latent competency profiles, and examine demographic and training-related attitude factors associated with profile membership. This cross-sectional study was conducted from January to October 2024 at a tertiary Grade A hospital in China. Eligible nurses were recruited voluntarily from multiple clinical departments in which TCM nursing services were routinely provided. A total of 457 valid questionnaires were analyzed. Data were collected using the Traditional Chinese Medicine Nursing Competency Questionnaire and a questionnaire assessing training-related attitudes and needs among TCM nursing staff. Latent profile analysis was used to identify competency profiles, and multinomial logistic regression was performed to examine factors associated with profile membership. The overall level of self-assessed TCM nursing competency was moderate. Scores were higher for TCM nursing techniques but lower for advanced clinical practice, indicating relatively limited advanced-practice and integrative application capacity. Latent profile analysis supported a three-profile solution (entropy = 0.846): low self-assessed competency (12.3%), moderate self-assessed competency (64.3%), and high self-assessed competency (23.4%) profiles. Profiles differed significantly in years of service, professional title, educational attainment, intention to participate in training, and perceived importance of training. In multinomial logistic regression, educational attainment, intention to participate in training, and perceived importance of training were consistently associated with membership in higher self-assessed competency profiles. Professional title was significant only in the high-profile contrast, whereas years of service was not independently associated with profile membership after adjustment. Clinical nurses working in departments where TCM nursing services were routinely provided showed heterogeneous patterns of self-assessed TCM nursing competency, with most nurses classified into the moderate self-assessed competency profile and advanced clinical practice emerging as a relative weakness. Profile-informed, tiered training strategies focusing on contextualized practice and clinical application may be warranted. However, given the cross-sectional design and reliance on self-reported data, the identified profiles should be interpreted as patterns of perceived competency rather than developmental stages or evidence of progression over time. Longitudinal or intervention studies are needed to further verify these associations. Not applicable.
Recent trends emphasise the importance of the nursing leadership in China and globally. However, research pertaining to nursing leadership interventions targeted at clinical nurses remains sparse in China. This study evaluated the impact of a leadership training programme on the nursing leadership, self-efficacy, and competency of clinical nurses working in intensive care units (ICU). A prospective, parallel-group quasi-experimental design was used. Thirty-five clinical nurses with the average age of 33.8 years from the ICUs of two tertiary comprehensive teaching hospitals were enrolled with 17 in the intervention group and 18 in the control group. The intervention group participants underwent an eight-session training programme tailored to clinical nurses. Each session lasted 60-90 min and focused on teambuilding, leadership and management skills, missions and goals, organisational culture and climate, emotional intelligence, communication skills, and implementing changes. The Nursing Leadership Scale, ICU Competency Self-assessment Questionnaire and General Self-efficacy Scale were used for pre-test and post-test evaluations. Semi-structured interviews were conducted with nine participants to complement quantitative measures. Data analyses were performed using thematic analyses. Significant positive changes were observed in the dimensions of nursing leadership: organisational, planning, interpersonal, and communication skills (P < 0.05). Intervention groups participants also scored higher on self-efficacy and ICU competencies than did controls (P < 0.05). Semi-structured interviews identified three themes: a broader understanding of nursing leadership, changes in personal thoughts and behaviour, and existing obstacles and expectations for future training. The targeted training programme effectively improved the leadership, self-efficacy, and competency of ICU clinical nurses. This study contributes to the existing literature by focusing on the development of clinical leadership among ICU nurses and by providing valuable support for nurse administrators to implement effective leadership education on a larger scale. Not applicable.
This study aimed to test the validity and reliability of the Thriving in Nursing Questionnaire, which is specifically designed for nurses, in Turkish. The study conducted between May and July 2025, participating nurses were asked to complete the 'Sociodemographic Information Form' and the 'Thriving in Nursing Questionnaire'. Considering a potential 10% data loss, the aim was to survey 165 nurses. A total of 164 nurses who completed all the survey items were included in the study sample. Those who did not consent to participate, had worked at the hospital for less than six months or incompletely answered the survey items were excluded from the study. Based on the confirmatory factor analysis, the modified three-factor model demonstrated acceptable-to-good fit (χ²/df = 1.544, RMSEA = 0.058, NFI = 0.904, CFI = 0.963, IFI = 0.964, and TLI = 0.953). The validity and reliability tests conducted in this study determined that the Thriving in Nursing Questionnaire is a valid and reliable measurement tool for the Turkish population. It is also believed that the scale will contribute significantly to improving the nursing workforce by enabling nurse managers to better understand these factors in management processes. Not applicable.
Pediatric nurses play pillar roles in providing continuous, holistic care for critically ill children. Hence, family satisfaction and nursing care competencies have surfaced as critical channels of quality of care in pediatric intensive care units. This study aimed to investigate the relationship between children's family satisfaction and nursing care competencies in Pediatric Intensive Care Units. A cross-sectional correlational research design was conducted in five pediatric intensive care units at children's hospitals related to different health sectors in Alexandria. A convenient sample of 150 pediatric critical care nurses who provided direct care for critically ill children in Pediatric Intensive Care Units (PICUs) and 218 families of critically ill children. The children's socio-demographic and clinical data record, the pediatric family satisfaction with care in the intensive care unit questionnaire, and the nurse professional competence scale-short version were used to collect data. The findings of the study showed that the mean score of overall pFS-ICU was 80.0 ± 5.75 and the mean score of overall NPC-SV was 101.75 ± 19.66. Additionally, a significant strong positive correlation was reported between the overall NPC-SV and overall families' satisfaction (r = 0.656, p < 0.001). Family satisfaction in the PICU is strongly influenced by nurses' medical and technical competence and their ability to deliver well-organized, accurately documented care. While interpersonal, educational, and leadership competencies remain essential components of holistic nursing practice. Not applicable.
The aim of this study was to evaluate the effect of creative, drama-based education on nursing students' perceptions of professional values, using randomised controlled trial (RCT) design. The study was conducted with 60 nursing students, who were selected through a G*Power calculation, from a population of 260 students studying at a foundation university in Istanbul. The experimental group attended five 90-minute sessions, once a week, incorporating creative drama techniques such as role-play, still image, forum theatre, case analysis and group discussions. The control group received the same content through traditional lectures. Data were collected using the Introductory Information Form and the Nurses' Professional Values Scale at pre- and post-test, and analysed using appropriate statistical methods in SPSS 25.0. Total and subscale scores on the Nurses' Professional Values Scale were significantly higher for the experimental group than for the control group (p < 0.05). Within-group comparisons revealed substantial improvements across all subscales in the experimental group (p < 0.01), whereas the control group exhibited only minor changes. Differences in some subscales were also observed according to whether or not participants had a healthcare professional in their family. Creative drama-based education may be an effective method for enhancing nursing students' professional values in the short term. The strengths of this approach lie in supporting active participation and enabling experiential learning of professional values. The study has been registered with ClinicalTrials.gov (NCT06875531). Registered on 10 March 2025. Although the application for ClinicalTrials.gov registration was submitted before the intervention began, the registration process was finalized and the registration number was assigned after participant recruitment had commenced due to administrative processing timelines. All primary and secondary outcomes, intervention procedures, and statistical analysis plans were pre-specified prior to the initiation of data collection.
Exploring barriers to applying theoretical knowledge and clinical skills among nursing trainees. Clinical placements are vital for connecting nursing theory with practice. However, barriers often hinder trainees from effectively applying their knowledge, undermining confidence, increasing turnover, and raising clinical risks. Existing quantitative studies have not fully captured the complexity of these barriers. This qualitative study uses the critical factors model to explore barriers across three dimensions: trainee traits, training design, and the work environment. A descriptive qualitative study. Employing a descriptive qualitative approach based on the critical factors model of training transfer. Barriers to training transfer in student nurses fell into three themes: trainee characteristics (low motivation, self-efficacy, and transfer capacity), training design (theory-practice disconnect, insufficient feedback), and the workplace (poor supervision, hierarchical culture, task-focused environment). This study provides empirical insight into and extends training transfer theory in Chinese nursing education, highlighting key influences on effectiveness, such as motivation, self-efficacy, and clinical culture. It recommends multi-level interventions to improve outcomes.
After at least one year of virtual learning due to COVID‑19, medical and nursing faculties varied in their return to in‑person training. The absence of in‑person environments may have affected professionalism components such as empathy, teamwork, and lifelong learning abilities, while also impacting students' mental health and wellbeing. The objective of this study was to measure that effect. A longitudinal study was conducted from 2020 to 2023 in the five medical and nursing faculties of Cusco, Peru. Two cohorts were followed: one with prolonged exposure to virtual learning and another with shorter exposure before resuming in‑person activities. Empathy (JSE), teamwork (JSAPNC), lifelong learning (JeffSPLL), depression (PHQ‑9), anxiety (GAD‑7), wellbeing (SWLS), and family loneliness (SELSA) were assessed with validated instruments, together with sociodemographic and academic variables. Analyses included reliability testing, paired and independent group comparisons, and multivariate regression models. A total of 417 students (233 medicine) completed both assessments; 137 (33%) had prolonged virtual exposure. Wellbeing was positively associated with lifelong learning, age, and shorter virtual exposure, but inversely with empathy and family loneliness. Risk of depression decreased with teamwork and in nursing students but increased in those enrolled in the clinical phase at baseline. Anxiety was associated with greater family loneliness, while a history of severe COVID‑19 illness was associated with lower risk. Students with shorter virtual exposure improved in empathy, teamwork, and learning abilities, whereas those with prolonged exposure did not. These findings indicate that prolonged reliance on virtual learning undermines professionalism‑related competencies, which are important for students' mental health and wellbeing. They also highlight the role of family support and the need for medical education to balance technology with in‑person training.
The transition from intensive care units to general wards is a critical and stressful phase in patient recovery, often associated with adverse psychological and clinical outcomes. Relocation Stress Syndrome (RSS) is a recognized condition resulting from this transition, highlighting the need for valid and culturally adapted assessment tools to accurately measure patient stress and guide nursing interventions. This methodological study was conducted to adapt and validate the Persian version of the Relocation Stress Syndrome Scale-Short Form (RSSS-SF). The final Persian version was administered to 155 patients who had been transferred from intensive care units (ICUs) to general wards in Tehran hospitals. Data were analyzed using IBM SPSS 29 and AMOS 24.Item-total correlations, Cronbach's alpha coefficients, and exploratory factor analysis (EFA) were conducted to examine internal consistency and factor structure. Confirmatory factor analysis (CFA) was subsequently performed to test the goodness-of-fit of the model. Model fit indices (χ²/df, CFI, GFI, AGFI, IFI, and RMSEA) and reliability coefficients were evaluated according to standard psychometric criteria. Exploratory factor analysis supported a three-factor structure for the Persian version of the RSSS-SF, explaining 57.97% of the total variance. The Kaiser-Meyer-Olkin value (0.74) and Bartlett's test of sphericity (χ² = 419.33, p < .001) confirmed sampling adequacy. Confirmatory factor analysis demonstrated acceptable model fit (χ²/df = 2.13, CFI = 0.91, RMSEA = 0.07). The overall internal consistency of the scale was acceptable. (Cronbach's α = 0.83). In summary, the Persian version of the RSSS-SF demonstrated satisfactory validity and reliability, generally supporting the factorial structure of the original instrument. The scale is a practical and culturally appropriate tool for assessing relocation stress among Iranian ICU patients and can facilitate the development of patient-centered, family-integrated nursing strategies to improve post-transfer adaptation and recovery. This study was approved by the Research Ethics Committee of the Tehran University of Medical Sciences, School of Nursing and Midwifery (Ethics Code: IR.TUMS.FNM.REC.1404.026). All participants were fully informed regarding the study objectives and procedures, and written informed consent was obtained prior to participation. Participation was voluntary, and confidentiality and anonymity of the collected data were assured. The study adhered to the principles of the Declaration of Helsinki. Not applicable. Data collection for this study was conducted between June 2025 and November 2025. All 155 participants completed the Persian short-form RSSS during the study period.
Emergency laparotomy carries high postoperative morbidity and mortality, requiring coordinated perioperative care to optimize recovery. Enhanced Recovery After Surgery (ERAS) protocols improve outcomes in elective surgery; however, their implementation in emergency settings remains complex. Limited evidence explores how nurses perceive and operationalize ERAS in high-acuity contexts. This study aimed to examine nurses' perspectives on the influence of ERAS protocols on postoperative recovery following emergency laparotomy in tertiary care. A qualitative descriptive design was employed, grounded in a constructivist-informed, descriptive epistemological orientation. Twenty registered nurses from surgical wards, intensive care units [ICU], high-dependency units [HDU], and post-anesthesia care units [PACU] in two tertiary government teaching hospitals in the Al-Ahsa region, Saudi Arabia, participated in semi-structured interviews. Participants had direct experience caring for patients undergoing emergency laparotomy and exposure to ERAS related practices. Interviews were audio-recorded, transcribed verbatim, and analyzed using reflexive thematic analysis. The study adhered to SRQR guidelines. Ethical approval was obtained from the Institutional Review Board of King Faisal University. Four interrelated themes were identified: (1) ERAS as a structured recovery roadmap providing measurable milestones; (2) balancing protocol and patient instability through adaptive modification; (3) nursing advocacy and clinical judgment as central mediators of implementation; and (4) system constraints, including staffing and institutional variability, shaping consistency. These findings informed the Adaptive ERAS Implementation Model, conceptualizing ERAS enactment as a dynamic, nurse-mediated and context-dependent process. ERAS implementation in emergency laparotomy is adaptive rather than checklist-driven. Its effectiveness depends on nursing leadership, interdisciplinary collaboration, and organizational support. Strengthening these elements may enhance sustainable recovery pathways in high-acuity surgical settings. Not applicable.
The transition from student to registered nurse is a demanding period marked by high expectations, emotional strain, and a need for rapid competence development. Structured onboarding programs are increasingly used to support newly graduated nurses, yet little is known about how mentors and leaders perceive their significance. This study explores these perspectives to deepen understanding of organizational and relational aspects of onboarding. A qualitative hermeneutic‑phenomenological design informed by Paul Ricoeur's theory of interpretation was applied. Eight semi‑structured interviews with mentors and leaders from medical, surgical, and oncology departments were conducted. Data were analyzed through Ricoeur's three interpretive phases: naïve reading, structural analysis, and critical interpretation. Four themes described how mentors and leaders understand and enact their roles in supporting newly graduated nurses. Balancing professional commitment in nursing onboarding highlighted the importance of early experiences for confidence and long‑term retention. Navigating individuality and structure in onboarding showed how standardized expectations are combined with tailored support. Being present yet invisible illustrated how mentors create psychological safety while promoting independence and reflective learning. Oscillating between standardized competence and evolving professional identity emphasized that the structured program strengthens clinical competence, supports identity formation, and contributes to a more stable workforce. There is an indication that such structured programs support care quality, competence development, professional identity, and retention. Mentors and leaders perceive structured onboarding as a relational and developmental process that extends far beyond administrative orientation. The findings suggest that structured programs enhance psychological safety, promote competence development, and foster a coherent professional identity. These elements contribute not only to newly graduated nurses' successful transition but also to workforce stability and care quality. Investing in comprehensive onboarding initiatives is therefore essential for sustainable nursing practice.
Maggot debridement therapy (MDT) is a biotherapeutic approach that uses sterile larvae to remove necrotic tissue and promote wound healing. Although its effectiveness in managing chronic wounds is well established, clinical adoption remains limited. Nurses are central to wound care, yet little is known about their MDT knowledge in Malaysia. This study assesses nurses' knowledge of MDT and examined the influence of demographic, professional, and educational factors within a tertiary teaching hospital setting. A cross-sectional study was conducted among 165 nurses selected through random sampling. Data were collected using a validated self-administered questionnaire assessing sociodemographic data, professional experience, and MDT knowledge. Descriptive statistics were used to summarize data, and Pearson chi square and Fisher's Exact test were applied to determine associations between knowledge levels and key variables. The mean age of participants was 32.72 years. Of these, 41.8% had 6-10 years of experience, 89.7% held a nursing diploma, and 87.9% had heard of MDT. Only 26.1% demonstrated high knowledge, while 52.7% showed low knowledge. A significant association was found between knowledge level and having heard of MDT (p = 0.040) and having performed MDT (p = 0.025). Nurses demonstrated limited knowledge and practical experience in Maggot Debridement Therapy despite general awareness of its clinical value. Knowledge was significantly associated with prior exposure and hands-on experience, underscoring the importance of experiential learning. Incorporating MDT into nursing curricula, continuous professional development, and institutional protocols is crucial to enhance evidence-based wound care and clinical adoption.
Post-traumatic osteoarthritis (PTOA) is a common and clinically important complication after ankle fracture surgery, but reliable individualized risk stratification remains limited. This study aimed to develop and externally validate a Cox-based risk prediction model for postoperative PTOA after ankle fracture surgery and to assess its incremental value over traditional early postoperative clinical evaluation indicators. This prospective two-center cohort study consecutively enrolled patients with surgically treated ankle fractures from Center I (March 2020 to March 2024) and Center II (March 2021 to March 2024). After screening 964 patients, 812 were included, with 605 assigned to the training cohort and 207 to the external validation cohort. Structural PTOA, the primary endpoint, was defined as the first occurrence of Kellgren-Lawrence grade ≥ 2 on postoperative weight-bearing ankle radiographs. Five incremental Cox models were developed using clinical, biochemical, nursing/perioperative, radiographic, and surgical variables. LASSO was used for feature selection, followed by multivariable Cox regression. Internal validation was performed using 1,000 bootstrap resamples, and external validation was conducted in an independent geographic cohort. The 2-year incidence of structural PTOA was 24.0% (145/605) in the training cohort and 29.0% (60/207) in the validation cohort. Fourteen variables entered the full multivariable Cox model, and 11 independent predictors were retained for the final parsimonious model. The final comprehensive model showed the best performance, with an apparent C-index of 0.892, a bootstrap-corrected C-index of 0.887, and an external validation C-index of 0.865. Relative to the postoperative 3-month AOFAS score as a clinically relevant reference comparator, the comprehensive model showed higher predictive performance, with a continuous net reclassification improvement of 0.785 and an integrated discrimination improvement of 0.285. Time-dependent ROC analysis demonstrated favorable discrimination at 6, 12, and 24 months in both cohorts. Calibration and decision curve analyses also supported good agreement and clinical utility. A prospective, multi-source Cox prediction model for structural PTOA after ankle fracture surgery was successfully developed and externally validated. The final 11-variable model demonstrated good discrimination, robust validity, and clear incremental value over traditional early postoperative clinical evaluation indicators, supporting its potential use for individualized risk stratification after ankle fracture surgery.
Pre-hospital Emergency Medical Services (EMS) providers serve a critical function in disaster response. While technical preparedness remains essential, psychological resilience is equally vital for sustaining performance amidst stressful conditions. This research endeavored to assess disaster readiness and resilience among EMS providers in Tehran Province, Iran, and to identify the factors associated with resilience. A cross-sectional analytical study was conducted in 2025, involving 467 pre-hospital EMS providers, using online self-administered questionnaires. Data collection encompassed demographics, Persian Version of the Disaster Nursing Readiness Evaluation Index (F-DNREI), and Disaster Resilience Measurement Tool. Descriptive statistics, correlation analyses, and multiple linear regression were employed to identify factors associated with resilience. Participants' mean disaster readiness score was 95.88 ± 10.62, whereas resilience mean score was 44.81 ± 9.50, with only 3.85% classified as highly resilient. Resilience was significantly correlated with readiness (r = 0.562, p < 0.001) and was positively associated with work experience, higher education, and prior attendance at a disaster management workshop. In the final multivariable regression model, age was excluded due to near-perfect collinearity with work experience, disaster readiness, holding a bachelor's degree, and prior workshop participation; these variables were retained as independent predictors of disaster resilience (R² = 0.606). Despite adequate disaster readiness, resilience was low, indicating a critical gap between technical preparedness and psychological adaptability. Education, experience, and prior training emerged as significant factors associated with resilience. Based on these observational associations, integrating simulation-based training with resilience-enhancement and psychosocial-support components warrants evaluation as a potential strategy to strengthen both readiness and adaptive capacity. Future research should examine these dynamics in real emergency scenarios.
Evidence-based practice (EBP) is central to high-quality nursing care and patient safety, yet its effective adoption and sustainability depend on nurses' capability to translate evidence into routine practice. Vascular access specialist teams (VASTs) play a key role in implementing evidence-based interventions to reduce complications associated with intravenous therapy, but little is known about their capability to enact and sustain EBP in complex organisational contexts. This study aimed to assess implementation competencies for EBP among VAST nurses in Spain. A two-stage, mixed-methods study was conducted in 2023. The quantitative stage involved a national cross-sectional survey of VAST nurses using an adapted questionnaire informed by behavioural frameworks relevant to EBP adoption. The qualitative stage consisted of in-depth semi-structured interviews with a purposive sample of participants. Quantitative data were analysed using descriptive and multivariate methods, and qualitative data through thematic analysis and integrated using triangulation. Fifty-one VAST nurses completed the questionnaire, reporting high self-perceived competence in domains such as social/professional role and identity (mean 4.7/5), knowledge (4.3), and collective context (4.2) for EBP. Lower scores were observed in contextual and organisational domains (mean 3.9), reflecting structural barriers to sustained EBP. Knowledge correlated positively with beliefs about capabilities (ρ = 0.574), and behavioural regulation (ρ = 0.591). Qualitative findings revealed five themes: expanded professional roles, experiential learning of implementation skills, context-sensitive strategies, organisational barriers, and enabling conditions. Participants described intuitive engagement with EBP despite lacking formal training, highlighting a gap between individual motivation and organisational support. VAST nurses in Spain show strong intrinsic motivation and emerging capability to lead and support EBP, but limited formal training and weak organisational infrastructure restrict their ability to enact and sustain implementation activities. Strengthening nurses' EBP capability through structured implementation training, alongside organisational strategies that formalise and support the VAST role, may improve the adoption and sustainability of evidence-based vascular access care.
Emergency department (ED) nurses manage intense emotional labor that contributes to burnout while simultaneously shaping resilience. Although burnout is a recognized hazard, the dynamic interplay between burnout and resilience within the Saudi Arabian healthcare context remains poorly understood. This study explored how ED nurses experience emotional labor and the relationship between burnout and resilience. A qualitative descriptive study was conducted with 17 ED nurses purposively sampled from three healthcare facilities in Riyadh, Saudi Arabia. Semi-structured interviews, lasting 38-67 min, were conducted between December 2025 and February 2026. Data were analyzed using reflexive thematic analysis, informed by emotional labor and Conservation of Resources theories. Trustworthiness was ensured through member checking, peer debriefing, and an audit trail. Reporting followed COREQ guidelines. Five themes were generated: (1) demands of emotional labor, including high-acuity care and emotional suppression; (2) manifestations of burnout, such as exhaustion and depersonalization; (3) resilience mechanisms, comprising peer support and professional meaning-making; (4) organizational influences, involving leadership quality and resource adequacy; and (5) participant-generated recommendations for systemic reform. Burnout and resilience were experienced as concurrent, dynamic processes modulated by the organizational environment. Burnout and resilience coexist as concurrent dynamic processes in Saudi ED nurses, with organizational factors, staffing adequacy, leadership quality, and mental health support, acting as decisive determinants of occupational wellbeing. Strengthening organizational accountability, rather than individual adaptation alone, is essential for sustainable emergency nursing practice.
A readmission is defined as an unplanned subsequent hospital admission in the same or a different hospital within 30 days after discharge from hospital due to the same illness. Readmission rates and its causative factors could be used to measure the quality of health care and accountability. Present study was undertaken to determine the incidence and causative factors of hospital readmissions at National Hospital Galle, Sri Lanka and to study the ongoing strategies for their prevention. This is a descriptive cross-sectional study. A pre-tested interviewer-administered questionnaire was used to collect data from re-admitted patients for consecutive seven days. Further data were collected from nursing officers (n = 102) who are participated in the patient discharge process at the same hospital to assess the strategies to prevent re-admissions. Data were analyzed using SPSS version 25.0, by using descriptive statistics, Pearson's test and Chi-square tests wherever applicable. This study assessed seven-day hospital readmissions among 4,492 patients admitted to the National Hospital Galle. A total of 946 patients were readmitted, during the study period giving an overall readmission rate of 21.06%. Most readmissions were planned (19.08%), while 1.98% were unplanned. Elderly patients (≥ 65 years) and those with multiple chronic conditions, including diabetes, hypertension, and heart failure, had higher readmission rates. Patients discharged within five days showed an increased risk of readmission. Readmitted patients reported lower satisfaction, particularly regarding communication and discharge instructions. Nursing staff surveys revealed dissatisfaction with discharge processes, inadequate patient education, limited post-discharge follow-up, and insufficient time and training for discharge counselling. Findings concluded that National Hospital Galle experienced a notable rate of general readmissions, while unplanned readmissions remained low. These return visits were heavily driven by patient dissatisfaction with post-discharge support and discharge communication. Consequently, this highlights a critical need to enhance patient education and follow-up protocols.
Saudi Arabia's Healthy Schools Program operates without dedicated school nursing professionals, instead relying on teachers who serve as health advisors. This study addresses the following question: What is the level of readiness for implementing the healthy school program? A cross-sectional design was adopted, and 242 public schools were surveyed using the School Health Index adapted for the Saudi context. Data were collected from health advisors (i.e. teachers without healthcare certification) working at primary, secondary, and high schools. Statistical analyses included descriptive statistics, t-tests, and Spearman correlations. Significant deficiencies were identified in physical education and staff health promotion. Specifically, low budget allocations for physical activity and minimal staff wellness initiatives were observed, which are systemic failures. Male students' schools largely experienced financial disparities, whereas female students' schools exhibited greater policy implementation and health education. The correlation analysis highlighted a reliance on external workshops rather than sustained clinical care. The absence of school nurses has created a leadership deficit, resulting in fragmented services, inequitable resource distribution, and inadequate emergency and chronic care management. Based on this study's findings, it is recommended that the Ministry of Education adopt a nurse-led model that aligns with the Saudi Vision 2030 goals and international best practices for school programs. Not applicable.
Working in the ambulance service is highly demanding, requiring new professionals to manage diverse, unpredictable patient situations from day one. New professionals often report limited self-confidence, emotional strain, and isolation, which can contribute to burnout, and turnover. Despite these challenges, in Sweden, education required for working in the ambulance service covers only a fraction of the essential competencies. Structured induction programmes are therefore critical for supporting new professionals. Although there is extensive knowledge about induction in hospital settings, little is known about induction in the ambulance service. Therefore, the aim of this study was to map the induction process of novice professionals in Swedish ambulance services. A descriptive study was conducted based on qualitative data from induction programme materials from 23 ambulance organisations, representing all 21 healthcare regions in Sweden. Data was analysed using document analysis. Analysis yielded six categories describing the content of the introductory training; Transportation and navigation; Cooperation and communication; Systematic work approaches and structures, Prerequisites for care and nursing; Safe healthcare environment; Organizational knowledge, and a seventh category describing Pedagogical approaches. The findings of this study highlight a need for more evidence-based and pedagogically coherent induction programmes within ambulance services. Induction should support not only technical and clinical competence, but also interpersonal, ethical, and person-centred aspects of care, while fostering professional socialisation, belonging, and psychological safety. As this study was based on documentary analysis, further research is needed to examine how different induction designs influence learning, clinical competence, and patient safety in ambulance care.
Although self-perceived burden (SPB), stigma and sleep quality are associated with quality of life (QoL) in patients with radiation-induced brain injury (RBI) after radiotherapy for nasopharyngeal carcinoma (NPC), little is known about the mechanism underlying the relationship among these variables. The aim of this study was to examine the relationship among SPB, stigma, and QoL, and further explore how sleep quality may moderate the effect of stigma. This cross-sectional study investigated 150 NPC patients with RBI who were recruited from an affiliated hospital of the university in Guangzhou, China. The participants completed several questionnaires, including a socio-demographic characteristics questionnaire, the Chinese version of the Self-Perceived Burden Scale (SPBS), the Social Impact Scale (SIS), the World Health Organization Quality of Life Instrument Short Form (WHOQOL-BREF), and the Pittsburgh Sleep Quality Index (PSQI). The mediation analysis and moderated mediation analysis were conducted using PROCESS macro Model 4 and Model 58 in SPSS 28, respectively. The results of mediation analysis showed that stigma had a significant indirect effect between self-perceived burden and quality of life (effect = -0.152, 95% CI = -0.223 to -0.032), and the direct effect of self-perceived burden on quality of life was not statistically significant (effect = -0.083, 95% CI = -0.300 to 0.134). In the moderated mediation analysis, the indirect effect of self-perceived burden on quality of life as mediated by stigma was apparent only among patients with poorer sleep quality (higher PSQI scores; effect = -0.115, 95% CI = -0.246 to -0.021). The findings suggest that stigma may function as a mechanism through which self-perceived burden is associated with quality of life in NPC patients with RBI, especially when patients suffer low sleep quality. Healthcare providers should pay attention to sleep quality and consider developing a supportive care intervention to improve patients' quality of life by incorporating effective strategies to reduce self-perceived burden and stigma for this population.
In the transition from compensated to decompensated cirrhosis, median survival decreases from 12 to two years, and patients face some of the highest rates of unplanned hospital admissions. Despite existing recommendations, palliative care is not routinely offered to this population. The aim of this study is to evaluate the effectiveness and implementation of an interdisciplinary palliative care intervention for patients with cirrhosis and their informal caregivers. The LiverCare study is a multi-center, mixed-method, pragmatic, non-randomised clinical study with a hybrid type 1 effectiveness-implementation design. The study is conducted in hepatology departments across four hospitals in three of Denmark's five regions. It is guided by the British Medical Research Council and Reach, Effectiveness, Adaption, Implementation, Monitor frameworks and includes both a feasibility study and a mixed-method process evaluation. The LiverCare intervention is grounded in a palliative approach, emphasising open, exploratory palliative care conversations. The intervention is integrated into routine outpatient care and the palliative care conversations are delivered by hepatologists and liver nurses who attended a specially designed course within palliative care. Eligible participants are adults with decompensated liver cirrhosis of any etiology who meet at least one general and one disease-specific palliative care indicator, assessed using the Supportive and Palliative Care Indicators Tool. Informal caregivers are invited to participate in the intervention. Palliative care conversations are initiated following a formal invitation and continue after four to ten weeks and then every six months up to 36 months or until study withdrawal or death. The primary outcome is healthcare utilization, defined as the number and length of hospital admissions, compared to a historic cohort. Secondary outcomes include outpatient contacts, symptom burden, quality of life, and caregiver burden. The study also includes cost-effectiveness and cost-utility analysis. Insights gained from the study will inform future implementation strategies and contribute to the advancement of palliative care practices in hepatology. The results will further support education, training, and competence development for healthcare professionals caring for patients with advanced liver disease. The study is registered on clinicaltrials.gov (NCT05431946), approved by The Danish Data Protection Agency and reported to the Committee on Health Research Ethics (20222000-31).