Background and Purpose: Natural disasters such as earthquakes create major challenges for families managing chronic illnesses, particularly children with diabetes. Earthquake-related stress intensifies the demands of disease management and increases family burden. Guided by the Family Management Style Framework, this study examined how parents' coping with earthquake stress influences their ability to manage their child's condition. Method: A descriptive, cross-sectional study was conducted with 140 parents of children with diabetes receiving care at a training and research hospital. Data were collected between March and June 2023 using an Information Form, Coping with Earthquake Stress Scale, and Family Management Measure. Descriptive statistics, Pearson correlation analysis, and multiple linear regression were used to analyze the data. Results: The findings revealed significant relationships between coping strategies and family management outcomes. Disease management was positively associated with family functioning (p < .05), while life challenges and lower parental agreement were negatively correlated with family management scores (p < .05). Regression analysis showed that earthquake stress coping strategies significantly predicted family management outcomes, explaining 26.2% of the variance (R² = .262, F = 2.402, p = .021). Implications for Practice: The parents' coping with earthquake-related stress is a significant predictor of family management outcomes, explaining 26.2% of the variance. Interventions that strengthen adaptive coping strategies, enhance family functioning, and support parental agreement may improve chronic disease management in children with diabetes following disasters. Health care professionals should prioritize psychosocial support and family-centered education to mitigate life challenges and support effective disease management in postearthquake settings.
Background: Moyamoya disease is a chronic cerebrovascular condition requiring ongoing self-management to prevent complications. Riegel's theory of self-care in chronic illness posits that factors such as disease knowledge, self-efficacy, social support, and access to care influence self-care maintenance, monitoring, and management, which in turn affect health outcomes and quality of life (QoL). Aim: To test a structural equation model of factors influencing self-care and outcomes in adults with moyamoya disease based on Riegel's self-care theory. Methods: A cross-sectional survey of 211 adults with moyamoya disease collected data on disease knowledge, self-efficacy, social support, access to care, self-care maintenance, monitoring, management, health status, and QoL (Korean version of the 12-Item Short Form Health Survey). Structural equation modeling was performed using IBM SPSS Statistics 30.0 and AMOS 30.0 to test the hypothesized model. Results: The proposed model demonstrated good fit. Disease knowledge, self-efficacy, social support, and access to care were significantly associated with self-care maintenance, monitoring, and management. These self-care processes, in turn, were positively related to better health status and higher QoL. The model explained a substantial proportion of variance in health status and QoL. Conclusion: The findings support the applicability of Riegel's self-care theory in moyamoya disease. Interventions to enhance patients' disease knowledge, self-efficacy, social support, and access to care may improve self-care and ultimately lead to better health outcomes and QoL in this population.
Background and Purpose: Barriers to patient recruitment, retention, and diversity are persistent challenges in clinical trials (CTs). With little evidence to advise best practices, clinical trials nurses (CTNs) remain an overlooked, patient-oriented resource. Applying a theoretical lens when investigating a complex problem ensures scientifically grounded inquiry and robust interpretation. The aims of this work were to evaluate the utility of D'Amour's structuration model of collaboration (SMC) for clarifying CTN roles and contributions; analyze how barriers to CTN collaboration affect research patient burden, safety, and participation; and examine how collaborative structures within the industry influence CTN involvement in CT design and conduct. Methods: SMC was selected as the theoretical mechanism because it functions reliably across organizational boundaries. A focused, theory-guided literature review was performed to map relevant evidence. Results: Findings indicated that CTNs represent a small, complex, and understudied specialty. Due to this niche status, CTNs have had limited representation within networks that facilitate disciplinary oversight and proactive patient advocacy. SMC articulates this relegation to downstream study operations. Although shared goals exist, a lack of CTN expertise in early study development perpetuates inefficiencies. This latent degree of collaboration is rooted in weak internalization and hindered by absent formalization and governance structures. Implications: CTNs are frequently cited as experts who enhance CT safety and overall success; however, this has not been thoroughly quantified. Therefore, in addition to CTN inclusion during CT design and protocol development, their consultative scope and impact must also be systematically measured and disseminated. Cultivating this knowledge could elevate CTN subspecialties into advanced practice status.
Background: Caring is central to nursing practice and education. While simulation is an effective modality to support the teaching of both technical and nontechnical skills, its impact on nurses' and nursing students' empathy and caring behaviors is less clear. Methods: A scoping review, guided by Arksey and O'Malley, Levac et al., and Joanna Briggs Institute frameworks and reported per Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews, searched CINAHL, PsycInfo, MEDLINE, and Health Source: Nursing/Academic Edition. The inclusion criteria were original research or randomized controlled trial, use of simulated patients, nursing participants, and outcomes related to empathy or caring behaviors. Results: Of the 129 studies, 8 met the criteria (2019-2023). All reported improvements in self-perceived empathy and caring across various study designs. Conclusions: Simulation may enhance empathy and caring, though further research is needed to confirm causality.
Background: The concept of professional identity is gaining traction within the nursing profession through intentional steps to define the concept and include it as an educational benchmark for all nurse graduates. Defining attributes of professional identity differ across professions, which necessitates comparison for a robust understanding. Purpose: The aim of this conceptual analysis is to identify defining attributes of one's professional identity in nursing by comparing conceptual usage of professional identity throughout history and current defining attributes within the professions of medicine, engineering, and teaching using the Walker and Avant method. Articles appraising the history of the concept of professional identity, conceptual definitions, or defining attributes within the profession were synthesized for comparison. Results: The nursing profession was late to recognize and conceptualize professional identity for individual nurses when compared with medicine, engineering, and teaching. Conceptualization of professional identity has surged in the last decade. Defining attributes of one's professional identity include perception and feeling as a member of a profession; individual values, beliefs, and actions that align with the larger profession; understanding of a distinct practice; foundational research-based knowledge through formal and ongoing education; and reflection on relationships and experiences that impact values and beliefs throughout a career. Implications for the Profession: A more robust conceptualization of professional identity has the capability of enhancing nursing theory, research, and practice to establish nurses with a strong sense of belonging within the profession.
Background and Purpose: Understanding the factors that influence nurses' willingness to volunteer during disasters is essential for fostering their active and sustained involvement in disaster preparedness efforts. The aim of the study is to conduct a concept analysis on nurses' volunteerism in disaster situations. Methods: Walker and Avant's concept analysis method was used to examine the concept of volunteering. Literature search was conducted in Web of Science, PubMed, ProQuest, ScienceDirect, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) Ultimate databases until July 2025 without any start date restrictions. Electronic databases were searched using the terms "Volunteer" OR "Volunteering" OR "Voluntarism" OR "Volunteerism" AND ("Disaster" OR "Emergency" OR "mass casualty incidents" OR "natural disaster" OR "humanitarian response") AND ("Nursing" OR "Nurse" OR "Nurs*"). Results: In the 44 studies analyzed, the main characteristics (social and professional responsibility, adaptability, teamwork, and ethical dimension), antecedents (individual and professional identity, disaster education, motivation and commitment, and incentives), and outcomes (professional and personal development, contribution to disaster health care, and social benefits) of volunteering in nursing during disasters were defined. Conclusions: This concept analysis revealed a preliminary model that includes the basic characteristics, antecedents, and consequences of volunteering in nursing during disasters. The model contributes to understanding the multidimensional nature and dynamic structure of volunteerism. Implication for Nursing Practice: This conceptual analysis defines volunteering in disaster situations as follows: characterized by social and professional responsibility, adaptability, teamwork, and ethical dimension; arising from individual and professional identity, disaster training, motivation and commitment, and incentives; and promoting personal, professional, and social benefits.
Background and Purpose: Menopause is a significant life stage that requires provider awareness and patient education to support informed decision-making. Inconsistent provider knowledge and increasing menopause-related concerns among perimenopausal women in a primary care clinic contributed to variability in assessment, counseling, and management. This project implemented a structured, evidence-based menopause education intervention to improve patient knowledge and support informed discussions in primary care. Methods: This 6-week quality improvement project enrolled women aged 40-55 years presenting for routine care or menopause-related symptoms. Participants completed anonymous pre- and postintervention surveys assessing menopause knowledge. The intervention consisted of a provider-guided education session using an evidence-based trifold pamphlet addressing symptom recognition, treatment options, lifestyle recommendations, and preventive health. Only fully completed surveys were included in the analysis. Results: Ninety-eight percent of participants reported the intervention as relevant to their needs. Survey findings demonstrated improved menopause knowledge. The structured pamphlet facilitated patient-provider discussions and increased awareness. Implications for Practice: Structured menopause education in primary care can improve health literacy, support informed decision-making, and enhance patient-provider communication. Promoting earlier recognition of symptoms can improve the quality of life for menopausal women.
Background: Annually, approximately 170,000 persons in the United States transition from foster care to independent adulthood, often with an abrupt discontinuation of essential support services. The immediate loss of vital supports often triggers a cascade of instability that flows into the financial, guardianship, and safety sectors. Purpose: The purpose of this review was to examine the small body of literature that explicitly applies Meleis’s Transition Theory to the experiences of individuals aging out of foster care and to synthesize the literature to more effectively assess transition conditions, patterns of response, and nursing therapeutics for this population. Methods: A theory-guided, integrative review was conducted to enhance the understanding of holistic, multifaceted phenomena. The articles were synthesized through the lens of Transition Theory to deepen understanding and inform nursing care planning for individuals aging out of foster care. Results: Findings were synthesized across three theory-informed domains: transition conditions, patterns of response, and nursing therapeutics. Across the studies, the literature consistently highlighted the importance of relational support, preparation for independence, and coordinated, transition-focused nursing interventions. Implications for Practice: Nurses encounter this population across a variety of clinical and community settings and are well-positioned to support healthy transitions to independence. Meleis’s Transition Theory assists nurses caring for this population in recognizing vulnerability, preventing secondary trauma, and connecting patients to resources beyond their scope of practice.
Background and Purpose: Nursing students need to recognize when clinical cues are important or nonessential. By using signal detection theory (SDT) to guide the analysis of nursing student responses, nurse educators can understand and categorize student learning needs to direct remediation. The purpose of this study is to describe and compare the nursing student- and nurse educator-identified needs for remediation after participating in a signal detection trial study for patient deterioration. Methods: A secondary analysis of qualitative data from a mixed-methods study that examined a convenience sample (n = 14) of second-semester senior nursing students from a cohort at a private university was conducted for the identified concept of remediation. The original data were collected using semistructured individual interviews, using a convenience sample. Data were analyzed using content analysis. Results: Two concepts emerged: student-identified remediation and researcher-identified remediation, with subconcepts of knowledge gaps and thinking deficits. Knowledge gaps included when students could not remember relevant information or when the researcher noted incorrect knowledge. Thinking deficits included when data were connected incorrectly or the wrong decision was made. Implications for Practice: Using SDT allowed researchers to identify the errors students were making in order for educators to better categorize errors and plan for effective remediation.
Aim: To report an analysis of the concept of moral distress among nurses caring for undocumented immigrants (UIs). Design: Concept analysis is the study design. Data Sources: Data sources included nursing and health care databases searched from 2015 to 2025. Eight articles were identified that addressed moral distress in the context of nursing care for UIs. Review Methods: Walker and Avant's method was used to identify definitions, antecedents, consequences, and empirical referents of the concept. Model, related, and contrary cases were developed to illustrate conceptual boundaries. Results: Defining attributes of moral distress among nurses caring for UIs included moral awareness, perceived or actual constraints, emotional and psychological distress, conflict between professional role and structural injustice or advocacy, and capability for reflection and growth. Antecedents were awareness of an ethical obligation or right action and encounters with UIs facing policy, institutional, or legal barriers. Consequences encompassed emotional and psychological effects such as guilt, frustration, sadness, burnout, and job dissatisfaction or turnover, moral residue, compromised patient care, and questioning of professional identity and values. Empirical referents included the Moral Distress Scale-Revised and the Moral Distress Thermometer. Conclusion: Moral distress is a pervasive and underexamined phenomenon for nurses who care for UIs. The analysis demonstrates that systemic constraints and ethical conflicts contribute to significant personal and professional consequences for nurses, ultimately threatening both workforce sustainability and delivery of equitable care. Conceptual clarity and empirical tools adapted for this context are needed to inform effective interventions.
Aim: The aim of this study was to identify the factors influencing preschool children's daily smartphone and tablet use and to evaluate the relative importance of these factors using machine learning models. Furthermore, the findings were discussed within the framework of Bandura's Social Learning Theory to examine the parental and environmental influences shaping children's screen time. Methods: This study was conducted in a district of Central Anatolia, Turkey, with data collected from the parents of children aged 4-6 years (N = 266). The data included children's daily screen time, purposes of device use, and parental digital habits. Analyses were performed using logistic regression, support vector machines, artificial neural networks, and XGBoost algorithms. Model performance was compared in terms of accuracy, F1 score, sensitivity, specificity, and area under the ROC curve values. Feature importance was also examined. Results: The child's purpose of device use was found to be the strongest predictor of screen time. In particular, using devices for educational content and turning to devices when bored were the most prominent determinants. Parents' daily screen use exceeding 3 hours and frequent social media use also significantly increased children's screen time. Parental guidance behaviors (e.g., coviewing content and setting limits) showed significant effects, whereas demographic factors contributed to a lesser extent. Conclusion: The study demonstrates that children's screen time is shaped not only by demographic characteristics but also by usage purposes and parental digital habits. It is recommended that parents act as role models, provide guidance in content selection, and enforce restrictions during critical periods.
Background and Purpose: Health care providers treating trauma survivors must be skilled in trauma-informed care (TIC) to maximize healing and avoid retraumatization. Few valid and reliable instruments are available to measure patient perceptions of TIC received in health care settings. The purpose of this project was to refine the TIC Patient-Perception Instrument in English and Spanish and to initiate the process of instrument validation to create a rigorous scale for use with Hispanic trauma survivors of interpersonal violence living on the U.S.-Mexico border. Methods: A methodological research design was used to establish content validity. TIC content experts completed Phase 1, Step 1 of the instrument development process. They reviewed and revised the TIC Patient-Perception Instrument to ensure that items representing the six core values of the TIC conceptual framework were included. In Phase 1, Step 2, a sample of Hispanic trauma survivors evaluated the instrument's items to ensure clarity, relevance, and alignment with TIC core values. Results: Trauma survivor participants provided feedback on the Spanish (N = 6) and English (N = 9) items. Item ratings ranged from 3.71 to 4.00 on a Likert-scale assessment, indicating moderate to very clear ratings of clarity, relevance, and the representation of TIC core values. Implications for Practice: A TIC Patient-Perception instrument that measures trauma survivors' perceptions through the lens of the six core values of TIC enables tailoring of culturally and linguistically competent TIC. It empowers health care providers to maximize TIC delivery to support the recovery of survivors of interpersonal violence across diverse populations.
Background and Purpose: Health care systems are characterized by significant unpredictability. For inpatient nurses, unpredictability is a work stressor that creates mismatches between work demands and available resources. Although unpredictability is recognized as a facet of nursing work, it has lacked formal conceptual analysis. This article examines and clarifies the concept of unpredictability within nursing work. Methods: Rodgers’ evolutionary approach was used to identify the concept’s defining attributes and contextual features, including its antecedents, consequences, surrogate terms, related concepts, and references. Inductive thematic analysis was used to analyze a total of 69 articles, identified through a systematic search of literature in CINAHL, Academic Search Complete, and MEDLINE databases. Articles that described unpredictability in the work, work processes, and/or work environment of inpatient nurses were included. Results: Unpredictability in nursing work arises from individual heterogeneity, uncertain diseases, dependence on shared resources, and system complexity. Nurses experience unpredictability in their patients’ acuity and care needs, personal safety, resource sufficiency, team dynamics, and workflow. Consequences of unpredictability include process inefficiencies, harm to nurse well-being, and negative impacts on patient care. This concept has demonstrated rising interest from multiple academic disciplines across the world. Implications for Practice: Concept analyses provide new insight into poorly defined phenomena within nursing practice. This article offers practicing nurses clarity into their own work, including the currently recognized causes, attributes, and consequences of unpredictability. Practicing nurses should advocate for policies and institutional strategies to address the drivers of unpredictability and better support nursing work.
Background and Purpose: Social determinants of health (SDOH) significantly affect health care outcomes on an individual, community, national, and global level. Clinicians must fully appreciate their impact and need standardized information defining the concept and its application in health care settings. Clarification is necessary to integrate the concept of SDOH into health care workplace mission statements, continuing education, formal academic institutions, and government guidelines. No formal concept analysis of SDOH exists using a standard nursing theory framework, despite growing awareness of the concept and the critical need for clinicians to apply it to theory-guided practice. This article provides the first formal nursing theory concept analysis using Walker and Avant's methodology. Methods: A literature review was conducted using the CINAHL Ultimate, PubMed Central, and Web of Science databases for peer-reviewed academic journal articles from the last 5 years. Walker and Avant's concept analysis method was applied. The concept of SDOH was explored along with antecedents, consequences, defining attributes, and limitations. Implications for practice and relevance to nursing were presented, and a case example was provided. No Institutional Review Board review was required. Results: A concept analysis was conducted using Walker and Avant's (2019) eight-step method. The concept analysis established the following defining attributes of SDOH: (a) neighborhood and physical environment, (b) economic stability, (c) education access and quality, (d) community, safety, and social context, (e) health care access and quality, and (f) planetary conditions. Implications for Practice: A clearly defined concept of SDOH allows for the standardization of educational materials, the creation of risk assessment screening tools, and integration into theory-guided practice and government practice guidelines. Recognizing SDOH can reduce clinician burnout and depersonalization in the presence of repeated poor outcomes, increase empathy for patients facing external obstacles, and foster humanizing health care interactions. Health care interventions can be better tailored to patient needs, improving evidence-based practice. Increasing policymakers' and clinicians' awareness of SDOH will decrease health care inequalities, promote social justice, and strengthen praxis, applying emancipatory knowledge into practice.
Background and Purpose: With nursing faculty vacancy rates on the rise, identifying and mitigating causative factors is imperative. The purpose of this study was to examine nursing faculty perceptions of work-life balance and identify strategies used to decrease burnout. Methods: A cross-sectional survey design was utilized. Items from the Oldenburg Burnout Inventory (OLBI) tool were combined with qualitative author-developed items and distributed to 65 nursing faculty. Descriptive statistics were used to determine exhaustion, disengagement, and burnout levels among participants. Qualitative items were analyzed for common themes. Results: A total of 24 respondents completed the survey. The OLBI results indicated 33% of participants had high-level disengagement, while 50% had high-level exhaustion. Higher exhaustion means for participants were associated with higher disengagement means, r = 0.78, p < .001. Qualitative thematic analysis revealed that setting boundaries, including turning work off and prioritization, helped in better balancing responsibilities, while lack of workplace support interfered with work-life balance. Those with the lowest OLBI scores reported feeling supported in their role and often set boundaries when work was performed. Faculty integrated strategies, including reaching out to peers and taking time for family and friends, to prevent burnout. Implications for Practice: Disengagement and exhaustion, both components of burnout, were identified in respondents. As faculty vacancy rates continue to increase, determining other variables impacting work-life balance is needed. Researching the effectiveness of interventions and preventative measures identified is necessary to support and retain future nursing faculty.
Background and Purpose: Effective diabetic foot ulcer (DFU) management critically involves wound care, pain management, and the development of patients' self-management skills. This study aimed to evaluate the effect of nursing care based on the Orem Self-Care Model on pain, activities of daily living, and wound size in patients with DFUs. Methods: This experimental control group study was conducted with 66 patients diagnosed with grade 2 DFU according to the Wagner classification. Data were collected using an Introductory Information Form, the Modified Barthel Index, and the Numerical Rating Scale. Statistical analysis utilized Mann-Whitney U, Wilcoxon Signed Rank Test, and Friedman Repeated Measures Analysis of Variance on Ranks tests. Results: At the study's outcome, no significant differences were found between the groups in terms of sociodemographic characteristics and disease data (p > .05). The Modified Barthel Index scores of the experimental group increased significantly each week, notably exceeding those of the control group in the third and fourth weeks (p < .05). Pain scores in both groups decreased significantly over time (p < .0001). Although the control group's pain scores were statistically significantly lower than the experimental group's in the second and third weeks (p < .05), this difference was not observed by the fourth week (p > .05). Although the wound area was initially higher in the experimental group, the wound healing rate in the experimental group (54.6%) was calculated to be higher than in the control group (35.6%).
Background: Real-time or clinical debriefing is considered an effective tool for promoting perinatal team dynamics, communication, patient safety, and perinatal outcomes. Several studies have investigated the outcomes of clinical debriefing in the obstetric (OB) setting. Purpose: We reviewed nursing debriefing practices after OB emergencies to examine the gap between principles and actual practices. This review focused on two key areas: (a) the effectiveness of OB debriefing in terms of communication, teamwork, and perinatal outcomes; and (b) the examination of current practices related to the standardization of debriefing. Study Design and Methods: This is a focused review of peer-reviewed research studies, posters, presentations, and abstracts. Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist, MEDLINE, Scopus, and Cumulative Index to Nursing and Allied Health Literature databases were searched using the search terms "obstetric emergencies," "real-time debriefing," "debriefing," and "perinatal emergencies." The initial yield was 307 records. Results: This review identified three key themes in the literature on real-time debriefing: the tools and requirements for effective debriefing; the impact on safety culture, communication, and team dynamics; and observations of distress and emotional healing. Conclusion and Clinical Implications: Standardizing best practices for debriefing after OB emergencies is essential. Developing a standardized tool or form is necessary to enable OB nurses to lead debriefing efforts confidently and competently after emergencies. Educating and empowering nurses to lead debriefing sessions following critical OB events can enhance teamwork, improve patient safety, and increase team members' satisfaction. Consistent use of debriefings is one way to promote desired professional behaviors while improving safety culture. A standardized debriefing tool for OB emergencies is crucial for quality improvement.
Background and Purpose: A need exists for a compassionate care model created for nursing education, with strategies that faculty can use for teaching students about compassionate care. Methods: A compassionate care model grounded in multidisciplinary theories and operationalized definitions was created for nursing academia. Results: The iCare Compassionately model was developed, and associated concepts were interwoven into organizational culture, first for faculty and staff as foundational content to facilitate role modeling opportunities. The model was then integrated comprehensively into the nursing curriculum. Implications for Practice: Through a care model developed specifically for nursing education, organizational culture can provide examples for nursing students of compassionate care. Further, by integrating compassionate care concepts throughout a curriculum, students receive focused education, resulting in new nurses being better equipped to deliver compassionate and clinically competent care to patients, as well as practice self-compassion to promote better nurse well-being.
Background and Purpose: Timely breast cancer treatment initiation after diagnosis is crucial for a better disease prognosis. The health belief model indicates that performing a health behavior is influenced by the person's health beliefs and cues to action. A scale to measure health beliefs and cues to initiate breast cancer treatment is needed. The purpose of this study is to describe the item development, content validation, and face validation of the new Determinants of Breast Cancer Treatment Initiation (DBCTI) scale. Methods: The items were developed based on a previous qualitative study. Eight experts tested the content validity index of the items (CVI). Five women with breast cancer evaluated the items for face validity. Results: Expert ratings and face validity feedback yielded 77 items, with an overall scale CVI of .97. The CVIs for the five subscales ranged between .93 and .99. Two items with a CVI less than .83 were retained for conceptual significance. Implications for Practice: The new DBCTI scale showed evidence of content and face validity. Further psychometric testing is warranted. This scale can be employed to assess factors influencing breast cancer treatment initiation in the clinical setting and to serve as an assessment tool to identify and address possible obstacles to early treatment initiation. Interventions can be designed to enhance early treatment initiation. .
