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To evaluate the effectiveness of an anesthesia recovery management model based on the ORTCC framework in patients undergoing painless gastrointestinal endoscopy. In August 2023, our hospital implemented an anesthesia recovery management model structured around the ORTCC model-comprising five components: Objective, Rules, Training, Check, and Culture. After a one-month pilot period, a total of 1000 patients were enrolled using a pre-post quasi-experimental design. Five hundred patients who underwent endoscopy before the implementation formed the control group (conventional care), while 500 patients treated afterward constituted the intervention group, receiving care under the ORTCC-based recovery model. Recovery time, incidence of anesthesia-related complications, frequency of nursing adverse events, and patient satisfaction were measured and compared between groups. Compared to the control group, the intervention group demonstrated significantly shorter anesthesia recovery times, lower rates of anesthesia-related complications and nursing adverse events, and higher levels of patient satisfaction (P < 0.05). The implementation of an ORTCC-based anesthesia recovery management model in patients undergoing painless gastrointestinal endoscopy was associated with enhanced recovery efficiency, reduced complication rates, and improved care safety. By integrating structured objectives, standardized rules and workflows, targeted training, performance assessment, and a culture of quality, this model provides a replicable framework for improving perioperative nursing outcomes and patient-centered care in ambulatory surgical settings.

Intraosseous access is a critical emergency procedure for rapid vascular access when peripheral intravenous insertion fails. Despite endorsement in emergency care guidelines, intraosseous use among clinicians remains limited, often due to inadequate exposure and procedural confidence. This quality improvement project evaluated the effectiveness of a low-cost, three-dimensional -printed simulation-based training intervention on emergency clinicians' intraosseous knowledge, technical proficiency, attitudes, and clinical utilization. A quasi-experimental, single-group pretest-posttest-follow-up design was implemented in a Midwestern community hospital. A total of 22 emergency clinicians completed a 3-phase "Crawl-Walk-Run" training program using anatomically realistic, three-dimensional-printed tibia/humerus intraosseous task trainers. Outcomes were assessed using the validated Intraosseous Training and Readiness Assessment in Nursing instrument and retrospective electronic medical record audits of nurse-initiated intraosseous insertions. Statistically significant improvements were observed in intraosseous knowledge (P < .001, g = 1.31) and technical skills (P < .001, g = 1.23), with sustained gains at 3-month follow-up. Confidence increased immediately post-training (P < .001) but declined modestly over time (P = .43). Electronic medical record review identified 5 successful nurse-initiated IO insertions within 3 months following the intervention, all achieving first-pass success, compared with 0 in the previous year comparison period. A low-cost, three-dimensional-printed simulation program significantly improved emergency clinicians' intraosseous knowledge, skill proficiency, and short-term clinical utilization. These findings support three-dimensional-printed simulation as a sustainable educational strategy to enhance readiness for high-acuity, low-occurrence procedures in emergency nursing practice.

To explore ward-based registered nurses' emotions, emotion-driven behaviours, and the perceived impact of these emotions on caring for clinically deteriorating patients. Clinical deterioration in ward patients is frequently missed or poorly managed despite widespread implementation of Early Warning Score systems. Behavioural and systemic factors may contribute to these failures; however, emotional influences remain underexplored. Descriptive interview study underpinned by Affective Events Theory. Registered nurses from a United Kingdom teaching hospital with experience caring for clinically deteriorating patients were purposively sampled. Semi-structured interviews were conducted using a topic guide informed by the seven Affective Events Theory constructs. Interviews were audio-recorded, transcribed verbatim, and analysed using a combined inductive thematic approach and deductive mapping to theoretical constructs. Five themes were identified and mapped to six of the seven Affective Events Theory constructs: work environment, work events, affective reactions, work attitudes, affect-driven behaviours and judgement-driven behaviours. The dispositions construct did not emerge as a distinct theme. Participants predominantly described negative emotional responses. Short-term coping strategies, including emotional distancing, supported care delivery but were perceived to increase longer-term burnout risk. Affect-driven behaviours included heightened vigilance and increased bedside presence; however, reluctance to leave deteriorating patients conflicted with established escalation protocols. Judgement-driven behaviours shaped longer-term attitudes, including reduced motivation and intentions to leave nursing. Emotional responses to clinical deterioration shaped immediate nursing behaviours that were both beneficial and potentially detrimental to patient care, while also influencing longer-term professional attitudes. Two patient and public involvement advisors reviewed the interview topic guide before data collection and contributed to the development of questions exploring the therapeutic relationship between nurses and patients.

Adolescents experienced significant psychosocial stressors during the COVID-19 pandemic due to movement restrictions, social isolation, and disruptions in routine, which adversely affected emotional regulation. As primary caregivers, parents play a critical role in supporting adolescents' emotional well-being, particularly during prolonged home confinement. Assertiveness training may enhance parents' ability to manage adolescents' emotional responses by improving communication, emotional control, and problem-solving skills. To determine the effectiveness of assertiveness training for parents in improving their ability to manage adolescents' emotional regulation. This study employed a quantitative quasi-experimental design with a control group. A total of 92 parents were recruited and allocated to either the intervention group (n = 46) or the control group (n = 46) using simple random sampling. The intervention consisted of assertiveness training delivered over six structured sessions, focusing on enhancing parents' assertive communication and emotional management strategies in addressing adolescent problems. Outcome measures assessed parents' ability to manage adolescent emotions before and after the intervention. Participants ranged in age from 22 to 65 years, with the largest proportion aged 43-45 years. Most respondents were married (82.6%), had adolescent daughters (43.4%), and had attained a low educational level (80.4%). Post-intervention analysis demonstrated a statistically significant improvement in parents' ability to manage adolescent emotions in the intervention group compared with the control group (p <0.05). An associated increase in adolescents' emotional understanding, as perceived by parents, was also observed following the intervention. Assertiveness training is effective in enhancing parents' capacity to manage adolescents' emotional regulation. Collaboration between the Department of Health and psychiatric nursing specialists is recommended to integrate assertiveness training into community-based mental health programs. Incorporating this intervention as a core competency for psychiatric nursing specialists in community health settings may strengthen family-centered mental health services, particularly during public health emergencies.

To map the existing knowledge in literature on the use of point-of-care ultrasound by critical care nurses in intensive and critical care settings, and to describe current practices, and examine reported training programme characteristics and outcomes. This scoping review followed the Levac et al. framework, building on Arksey and O'Malley, and adhered to the PRISMA-ScR guideline. A systematic literature search was conducted without any time restriction until October 2025 across PubMed/MEDLINE, Scopus, CINAHL, Web of Science, and Embase. Data were extracted, collated, and classified to identify key patterns. Findings were synthesised through tabulation and a narrative summary to map the evidence comprehensively. A total of 305 records were identified, of which 17 studies were included. Across the included studies, nurse-performed point-of-care ultrasound in critical care settings was applied within three overarching domains of patient care: 'verification and guidance of clinical procedures', 'cardiopulmonary assessment', and 'additional diagnostic purposes'. Training programmes for critical care nurses varied widely in duration, content, delivery methods, and assessment strategies, and reported outcomes were related to clinical practice, patient experience, and professional development. Nurse-performed point-of-care ultrasound is increasingly incorporated into intensive and critical care settings suggesting potential clinical and professional benefits. Persistent heterogeneity in training models, competency assessment, and defined scope of practice reveals an absence of standardised frameworks necessary for consistent and sustainable adoption. Policies are needed to standardise scope of practice, training, and competency assessment for critical care nurses using point-of-care ultrasound. Integration of point-of-care ultrasound into critical care nursing education should be supported to ensure consistent preparation and skill development. Clear oversight and competency processes are needed to promote patient safety and sustainable implementation. Policy frameworks should also recognise point-of-care ultrasound as a pathway for professional development and role advancement among critical care nurses.

To explore the experiences, evolving needs, key pain points, and service touchpoints of patients with temporary ostomies during the dual transition, and develop a patient journey map to guide nursing practice and enhance patient experience. A descriptive qualitative study following the Standards for Reporting Qualitative Research (SRQR). Between December 2025 and March 2026 in Shanghai, China, 19 patients with temporary ostomies were recruited. Data were collected via semi-structured interviews, analysed using framework analysis, and synthesized into a visual patient journey map. Thirty-two initial codes were identified and, guided by the Fitch supportive care needs framework, synthesized into four dimensions and 16 subthemes. Mapped across four stages of the patient journey: (1) preoperative phase, characterized (survival-driven decision-making and limited understanding); (2) early postoperative phase, marked (tangible impacts and a knowledge-action gap in skill acquisition); (3) transitional care phase, (trial-and-error adaptation and lifestyle reconstruction); and (4) stoma reversal waiting phase, (tension between the desire for "normalcy" and uncertainty regarding bowel function). The visual patient journey map reconstructs the patient experience, highlighting stage-specific behaviours, emotions, needs, and key pain points from initial stoma creation to the stoma reversal waiting phase. This study highlights the phase-specific supportive care needs of patients with temporary ostomies across the identified journey phases. The resulting patient journey map offers insights into key pain points, the progression of needs, and the complex interplay among behaviours, emotions, and service touchpoints. Future research and clinical practice could explore digitally supported follow-up systems, family-centered dyadic empowerment strategies, and front-loaded risk communication as potential avenues to enhance care. Participants contributed to this study by sharing their lived experiences through semi-structured interviews. Three participants also participated in member checking to validate the interpretation of the findings and provide feedback to refine the final map.

The Basque Country is one of Europe's many stateless nations and home to the Basque Indigenous population. As members of an Indigenous and ethnic minority culture, Basque women and gender non-normative individuals risk suboptimal healthcare services and outcomes because of gender bias and discrimination. This study explores their experiences with healthcare services and identifies the ways in which gender bias and discrimination serve as a barrier to cultural safety in the Basque Country. We used critical ethnography and triangulated data from 37 semi-structured interviews, health clinic observations, 4 focus groups, and document analysis. Thematic analysis was used to identify overarching themes from transcripts and field notes. Participants reported numerous instances of discrimination that hinder the implementation of cultural safety. We found that gender bias and discrimination are central to the healthcare experiences of Basque women and gender non-normative individuals. These issues manifest in various ways, including knowledge transmission gap regarding women's health, discrimination based on sexual and/or gender identity, and obstetric and gynecologic violence. Meanwhile, patient autonomy during healthcare encounters is a key facilitator. Training in self-reflection, bias awareness, and gender-affirming can reduce discrimination. Findings also highlight clinical knowledge gaps and the need to integrate cultural safety into nursing education and practice.

ObjectiveTo explore factors associated with willingness to reuse rubber dam isolation after microscopic root canal treatment and develop an exploratory machine learning-based early post-treatment assessment model.MethodsThis retrospective cross-sectional study included 306 patients who underwent microscopic root canal treatment with rubber dam isolation from May 2025 to November 2025. The outcome was the willingness to reuse rubber dam isolation at the 1-week follow-up. Forty-seven newly enrolled patients were reserved as a same-center temporal validation cohort, and the remaining 259 patients formed the development cohort, which was divided into training and held-out test sets in a 7:3 ratio. Data regarding 26 demographic, clinical, procedural, nursing-related, and post-treatment experience variables were collected. Preprocessing, recursive feature elimination with cross-validation, and hyperparameter tuning were integrated within a fully nested cross-validation pipeline using the training data only. Six machine-learning models were compared. SHapley Additive exPlanations and generalized additive models were used for exploratory model interpretation. A sensitivity analysis excluding satisfaction level was also performed.ResultsOverall, 246 patients were willing to reuse rubber dam isolation and 60 were unwilling. The Light Gradient Boosting Machine model showed the best exploratory performance, with area under the receiver operating characteristic curve values of 0.939 and 0.983 and F1-scores of 0.94 and 0.96 in the held-out test set and same-center temporal validation cohort, respectively. Recursive feature elimination retained 12 predictors. SHapley Additive exPlanations analysis suggested that satisfaction level and postoperative visual analog scale score were the leading model-associated factors. After satisfaction level was excluded, the area under the receiver operating characteristic curve decreased to 0.820 and 0.840 in the two evaluation cohorts. Given the small temporal cohort, especially the 14 patients unwilling to reuse rubber dam isolation, this estimate was considered preliminary and potentially imprecise.ConclusionThe model identified satisfaction, postoperative pain, discomfort-related factors, and procedural variables associated with willingness to reuse rubber dam isolation. Prospective multicenter validation is required before clinical implementation.

The experience of grief within neurosurgery extends across a diverse range of individuals, including patients, but also caregivers, neurosurgeons, trainees, advanced practice providers, and the nursing staff who care for neurosurgical patients. This congregation of individuals constitutes the sacred thread woven in the circle of neurosurgery. This interconnected circle is united by a string of life-changing experiences, most of which are profoundly rewarding. However, some experiences leave a deep, regretful mark on the "self," even when the highest standards are upheld in the operating room. In this article, authors from different expertise combine to discuss the factors that encompass the experience of grief among those who face the terminal phases of their lives, their loved ones, and those who incurred grief from the act of doer-ship (neurosurgeons and providers). The authors discuss the different dynamics of grief at play between these cohorts, which may be insightful for those caring for them, and delve into psychological and spiritual reflections on their potential roles in coping mechanisms. They introduce the concept of ikigai in the context of grief, particularly in conjunction with evidence-based breathwork and meditative practices.

Digital health platforms are intended to democratize healthcare, yet they often encounter the "digital health paradox," where tools primarily benefit those with high digital literacy. In the Principality of Asturias (Spain), the Mi asturSalud portal was implemented to foster patient co-responsibility, but its actual usage patterns and equity determinants remain under-researched. To identify distinct behavioral user profiles and analyze the sociodemographic determinants of portal adoption, as well as the predictors of perceived digital barriers, in a Primary Care setting. A multicenter cross-sectional study was conducted (N=384) across four health districts. Predictors of portal adoption and digital barriers were analyzed using mixed-effects logistic regression models, with the health center as a random effect to account for data nesting. Among active portal users (n=138), hierarchical cluster analysis was performed to identify distinct engagement patterns, utilizing the elbow method for cluster selection and Pearson's chi-square tests for profile comparison. Two distinct user profiles emerged: "Comprehensive clinical users" (72.5%), who autonomously access clinical data, and "Limited administrative users" (27.5%), whose interaction is confined to basic transactional tasks. Mixed-effects models revealed that adoption is primarily driven by individual sociodemographic factors, particularly educational attainment and age, rather than geographic or institutional context (ICC = 0.026). Education proved to be a more potent predictor than household income. Significant barriers to engagement included credential complexity and a lack of functional literacy regarding clinical features, disproportionately affecting users with lower educational attainment. A significant "functional divide" exists, where a segment of the population remains limited to superficial administrative interactions. Digital inequality is a transversal issue rooted in individual capabilities and social support structures. Achieving digital equity requires moving beyond mere technical access toward personalized interventions, with Primary Care nursing serving as a critical mediator for fostering functional health literacy.

Fallopian tube carcinoma is frequently detected at an advanced stage, and its imaging findings and tumor marker profiles are often indistinguishable from those of ovarian or peritoneal carcinoma. Nontuberculous mycobacteria (NTM) are environmental acid-fast bacilli with increasing clinical significance in both immunocompromised and immunocompetent individuals. Infection of gynecologic organs is extremely rare. This report describes a case of fallopian tube NTM infection caused by Mycobacterium abscessus that mimicked fallopian tube carcinoma. An 87-year-old woman underwent fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) during routine surveillance, which revealed focal FDG uptake in the right adnexal region. Serum CA125 was elevated, and magnetic resonance imaging demonstrated findings suspicious for fallopian tube carcinoma. Primary debulking surgery was performed. Intraoperative frozen-section examination of the right adnexa revealed necrotizing granulomas without evidence of malignancy, raising suspicion of mycobacterial infection. Fresh specimens were submitted for microbiological evaluation. Culture identified Mycobacterium abscessus, establishing the diagnosis of fallopian tube NTM infection. The patient was asymptomatic and had no abscess formation. Complete surgical resection was achieved, and no antimicrobial therapy was administered. The patient remained recurrence-free at 1-year follow-up. This case highlights the difficulty of differentiating infectious granulomatous disease from malignancy based on imaging findings alone. Intraoperative frozen-section examination played a crucial role in prompting microbiological investigation and establishing the correct diagnosis.

The purpose of this study was to identify an association between two of the most common comorbidities of hemodialysis patients affected by COVID-19, namely hypertension and diabetes mellitus, and mortality. This research was an analytical study with a case control approach. The subjects of this study were patients undergoing hemodialysis with comorbid hypertension and diabetes mellitus who were confirmed positive for COVID-19. They were divided into two groups; the case group consisted of patients who died, and the control group consisted of patients who were living. The total number of respondents was 50. The data were taken from the status medical records of patients in two hospitals in North Jakarta. There was a significant relationship between comorbid hypertension and diabetes mellitus with mortality in hemodialysis patients with COVID-19 (p = 0.014). Hemodialysis patients affected by COVID-19 with comorbid hypertension have a risk of dying that is 0.172 (odds ratio, OR) times greater than hemodialysis patients with comorbid diabetes mellitus. Patients with confirmed COVID-19 with dialysis-requiring chronic kidney failure and other comorbid diseases have a risk of heightened disease severity and even death. Therefore, comorbidities must be controlled in these patients.

Continuing medical education (CME) is crucial for maintaining the competency of general practitioners (GPs). Understanding factors associated with GPs' perceived necessity of CME is essential for optimizing training programs, especially in resource-constrained regions. This study aimed to identify factors associated with GPs' perceived necessity of CME in Southeast Henan, China. A cross-sectional survey was conducted among GPs in Zhoukou City, Southeast Henan, from August to September 2024. Data were collected via an online questionnaire. The primary outcome was the perceived necessity of CME (binary: yes/no). Univariable and multivariable logistic regression analyses were employed to identify factors associated with this outcome. Structural equation modeling (SEM) was used to explore pathways linking CME policy cognition, self-efficacy, attitude towards CME, and perceived necessity. Among 5537 eligible registered GPs, 2,480 valid responses were obtained (response rate, 44.8%). Overall, 35.6% perceived CME as necessary, whereas 89.6% had participated in CME during the previous three years. In the multivariable model, understanding the linkage between CME credits and career advancement showed the strongest positive association with perceived CME necessity (adjusted odds ratio [aOR]=3.74, 95% CI: 2.97-4.72). Organizational support (aOR=1.76), high self-directed learning ability (aOR=1.60), absence of anxiety (aOR=1.37), and more than 30 years of practice experience (aOR=1.58) were also positively associated with perceived CME necessity. The perceived necessity of CME among GPs was associated with policy awareness, organizational support, psychological factors, and professional experience. These findings may inform policy transparency, organizational support, and tiered CME curricula that address the needs of GPs with different competency levels.

The aim of this study was to identify how Peer Support Workers (PSWs) understand their scope of practice, to provide greater clarity for PSWs working in addiction care with interprofessional teams. We conducted semi-structured interviews with PSWs and analysed the results using qualitative description. We interviewed 17 PSWs from a variety of backgrounds. We identified five descriptive themes that illustrate how PSWs delineated their scope of practice: building relationships with clients, therapeutic engagement with clients, system navigation, providing supplies to clients, and professional development. PSWs had a clear sense of their scope of practice and how they could be most effective, despite a lack of recognition of this scope in their workplaces. By creating a preliminary description for a PSW scope of practice, we hope that PSWs and nurses can work together to support the PSW professional role, enhancing patient outcomes.