Background/Objectives: Immersive virtual reality (VR) is increasingly used during pediatric procedures, but intervention effects vary across children, procedures, devices, comparators, and outcomes. This review synthesized recent evidence and developed a proposed developmentally informed child-procedure-intervention framework for clinical matching. Methods: A structured narrative review synthesized 96 publications identified through PubMed, Scopus, Web of Science Core Collection, the Cochrane Library, and CINAHL through 31 July 2026. Explicit searching, eligibility criteria, screening, and structured evidence characterization were used to improve transparency; however, this was not a systematic review, and no formal risk-of-bias or certainty-of-evidence assessment was performed. Evidence was interpreted according to publication type and organized by clinical context, developmental modifiers, intervention characteristics, implementation, biofeedback, and future AI-supported decision support. Results: The most recurrent favorable findings concerned venipuncture, intravenous access, vaccination, and related needle procedures, particularly against usual care, whereas comparisons with active distraction and evidence from oncology, burns, dentistry, orthopedics, surgery, and emergency care were more mixed. The narrative synthesis identified developmental readiness, baseline anxiety, previous procedural experience, sensory tolerance, content, interactivity, immersion, timing, comparator, concurrent analgesia, and patient preference as plausible moderators, although their predictive value remains insufficiently validated. The author-generated framework links nursing assessment, purpose-based VR selection, monitoring, stopping criteria, and clinically approved adjustment. Conclusions: Pediatric procedural VR should not be treated as a uniform intervention. The proposed framework is evidence-informed and hypothesis-generating, not a validated clinical decision model. Biofeedback is supported by preliminary pediatric evidence, whereas AI-supported adaptation remains a future research and translational opportunity requiring prospective validation, governance, and continuous clinical oversight.
Background/Objectives: Postoperative delirium is a frequent and clinically relevant complication among adult patients admitted to intensive care units (ICUs) following major surgery. It is associated with increased morbidity, prolonged hospitalization, functional decline, and greater healthcare burden. Although non-pharmacological interventions are widely recommended for delirium prevention, evidence regarding their effectiveness in postoperative critically ill adults remains heterogeneous. This systematic review aimed to evaluate the effectiveness of non-pharmacological interventions in preventing postoperative delirium in adult ICU patients. Methods: This systematic review was conducted according to PRISMA 2020 guidelines. Searches were performed in PubMed/MEDLINE, Embase, CINAHL, Cochrane CENTRAL, Web of Science, Scopus, LILACS, and Google Scholar. Eligible studies included randomized controlled trials, quasi-experimental studies, and comparative studies evaluating non-pharmacological interventions for postoperative delirium prevention in adult ICU or critical care patients. The primary outcome was postoperative delirium incidence. Secondary outcomes included delirium duration, delirium severity, ICU length of stay, and postoperative sleep quality. Studies reporting sleep-related outcomes without directly assessing delirium were included only in the qualitative synthesis as indirect supportive evidence and were not used to estimate the preventive effect on delirium incidence. Results: A total of 26 studies were included in the qualitative synthesis, of which 14 provided sufficient dichotomous data for the primary meta-analysis of delirium incidence. The remaining studies contributed qualitative evidence on non-comparable delirium outcomes, sleep-related outcomes, or the management of established delirium. Non-pharmacological interventions significantly reduced the risk of postoperative delirium compared with control conditions (RR = 0.61; 95% CI: 0.48–0.78; I2 = 25.2%). Conclusions: Non-pharmacological interventions were associated with a significant reduction in postoperative delirium incidence among critically ill adult patients. The certainty of the evidence for this outcome was moderate, and an analysis restricted to randomized controlled trials produced a consistent result. Further high-quality randomized controlled trials are required to standardize intervention protocols and clarify their effects on secondary clinical outcomes.
Background: In the wake of the COVID-19 pandemic, nursing students and educators are navigating an increasingly complex academic environment. The rigorous demands of nursing education, combined with diminished academic preparedness and growing mental health concerns, have heightened the need for effective wellness interventions. The SKY Happiness Retreat©, an evidence-based program incorporating breathwork, meditation, and mindfulness practices, offers a potential strategy to enhance student resilience and reduce stress. Purpose: This pilot study examined the impact of integrating the SKY Happiness Retreat© into a Bachelor of Science in Nursing (BSN) program. This study evaluated whether participation reduced perceived stress and improved students’ ability to manage stressful situations. Methods: A quasi-experimental pretest–post-test design was used with junior-level BSN students recruited through convenience sampling at a rural university. Participants completed a structured three-day retreat focused on breathwork, meditation, and mindfulness. Outcomes were measured using the Mood and Anxiety Symptom Questionnaire (Mini-MASQ), the Perceived Stress Scale (PSS), and the Brief Resilience Scale (BRS). Results: Perceived stress significantly decreased following the intervention (PSS: pre M = 18.50, SD = 4.583; post M = 17.30, SD = 5.841; t(43) = 2.072, p = 0.022). General distress also significantly improved (Mini-MASQ: pre M = 15.51, SD = 6.535; post M = 12.82, SD = 5.118; t(44) = 3.941, p < 0.001). No significant changes were observed in anxious arousal or anhedonic depression. BRS scores demonstrated a modest increase in resilience. Conclusions: The SKY Happiness Retreat© shows promise as an experiential learning strategy within undergraduate nursing education. Findings suggest participation was associated with reductions in perceived stress and general distress while promoting resilience. Integrating evidence-based wellness programs into prelicensure nursing curricula may better prepare students to manage academic and professional stress. Larger, longitudinal studies are needed to evaluate long-term effectiveness.
Background/Objectives: Postoperative thirst is a common and distressing symptom among surgical patients; however, standardized management guidelines remain limited. Oral care interventions using cold stimulation (e.g., ice chips, popsicles, and menthol-infused products) may relieve postoperative thirst, but variation in intervention protocols and outcome measures has so far precluded clear clinical recommendations. This protocol outlines a systematic review evaluating the effectiveness of cold-stimulation oral care interventions in reducing thirst intensity among adult surgical patients during the immediate postoperative period, defined as the first 6 h after emergence from general anesthesia. Methods: Randomized controlled trials (RCTs) comparing cold-stimulation oral care with standard care will be included; as pre-specified at registration, quasi-randomized trials will be considered only if fewer than three eligible RCTs are identified (appraised with ROBINS-I and reported separately). MEDLINE, Cochrane Library, EMBASE, CINAHL Plus and trial registries were searched. Risk of bias will be assessed using the Cochrane Risk of Bias tool version 2.0. The primary outcome is change in thirst intensity; secondary outcomes are oral dryness, patient satisfaction, and adverse events. Continuous outcomes will be pooled as mean differences, or as standardized mean differences across differing scales, and dichotomous outcomes as risk ratios, with 95% confidence intervals. Random-effects meta-analysis will be performed in R where appropriate, otherwise narrative synthesis, with pre-specified subgroup and sensitivity analyses. Certainty of evidence will be rated using GRADE. Conclusions: This protocol was developed in accordance with PRISMA-P and prospectively registered in PROSPERO (CRD420251139881). The review will clarify the effectiveness and safety of cold-stimulation oral care for postoperative thirst and support perioperative nursing practice.
Introduction: Dating violence is an early form of intimate partner violence characterized by controlling behaviors, psychological and sexual abuse, and digital coercion. Despite its high prevalence among adolescents and young adults, it remains underrecognized and insufficiently addressed in healthcare settings. Nurses are strategically positioned to identify and respond to dating violence due to their close contact with patients and holistic approach to care. However, important gaps remain between existing protocols and their implementation in clinical practice. Methods: An exploratory qualitative study was conducted within a constructivist paradigm as part of a multicenter research project on dating violence among health sciences university students. Twelve experts, including nurses, healthcare professionals, and representatives of survivor-led organizations, participated in focus groups and reflective journals between September and December 2025 at the University of Barcelona. Data were analyzed using an interpretative phenomenological approach, with inductive thematic analysis guiding coding and theme development. Methodological rigor was ensured following the Consolidated Criteria for Reporting Qualitative Research (COREQ). Ethical approval was obtained. Results: Four themes emerged: (1) barriers to identification, including the normalization of controlling behaviors, myths of romantic love, and limited recognition of psychological and digital violence; (2) challenges in nursing responses, such as insufficient training, clinical uncertainty, organizational barriers, and lack of screening tools; (3) identification strategies, including systematic screening, relationship-centered interviewing, emotional education, and recognition of subtle warning signs; and (4) actions following identification, focused on validation, confidentiality, risk assessment, interdisciplinary referral, and ongoing support. Conclusions: Findings highlight the need to update protocols to explicitly address digital violence and strengthen nursing-led interventions. Participants emphasized the need for enhanced professional training, context-appropriate screening tools, and intersectoral collaboration as potential strategies to improve the identification and response to dating violence.
Background/Objectives: Person-centered care (PCC) and the Technological Competency as Caring in Nursing (TCCN) theory are increasingly emphasized in nursing leadership, but no published study has evaluated a PCC/TCCN training program among Mongolian nurse managers. This uncontrolled, single-group pilot pre–post study examined immediate changes in nurse managers’ self-reported PCC and TCCN perceptions following a one-day collective training program. Methods: The program was delivered on 30 October 2025 during the 2nd International Nursing Symposium in Mongolia. Using convenience sampling, hospitals were invited to send nurse managers who were currently in post or senior nurses who had been formally nominated for such a role. Of 50 attendees, 30 met a pre-specified role-eligibility criterion and formed the matched pre–post analytic sample. Participants completed Mongolian versions of the Person-Centered Care Instrument (PCCI) and the Perceived Technological Competency as Caring in Healthcare Providers Instrument (TCCHI) immediately before and after the program. Pre–post differences were assessed with Wilcoxon signed-rank tests, effect sizes for the Wilcoxon signed-rank test (r = z/√N), and Holm–Bonferroni correction across 16 comparisons. Results: Total and all concept-level PCCI and TCCHI scores were higher after the program than before it, all 16 comparisons remained significant after correction, and the effect sizes were moderate to large (r = 0.41–0.61). The median within-person change was +22.0 points (95% CI 7.0 to 35.5) for the total PCCI score and +24.0 points (95% CI 10.5 to 38.0) for the total TCCHI score (Hodges–Lehmann estimates). Conclusions: In this small convenience sample of Mongolian nurse managers and senior nurses formally nominated for managerial roles, self-reported PCCI and TCCHI scores increased immediately after a one-day training program. Because the study used a single-group design without a control group, employed instruments not yet fully validated in Mongolian, and included no follow-up, these findings are preliminary evidence of an association rather than proof of program effectiveness. Larger, controlled studies with follow-up are needed. Trial Registration: TCTR20260513001, registered retrospectively on 13 May 2026, after data collection had been completed.
Background/Objectives: Nursing diagnoses (NDs) support clinical reasoning, individualised care planning, and the visibility of nursing practice, yet their implementation remains inconsistent. This study prospectively examined whether TPB-informed beliefs, attitudes towards NDs, behavioural intention, and the nursing practice environment were associated with initial ND use and subsequent documentation intensity. Methods: A prospective observational cohort study was conducted across 14 adult inpatient units within a public healthcare organisation in Northern Italy. Baseline questionnaire data were linked with electronic nursing records, workforce data, and ward-level administrative data. Initial use was defined as documentation of at least one ND during follow-up. Results: The primary cohort included 144 nurses, of whom 122 (84.7%) documented at least one ND. Greater work exposure was associated with initial use (OR = 1.71, 95% CI [1.12, 2.60]). After additional adjustment for the overall PES-NWI, behavioural beliefs (OR = 1.93, 95% CI [1.09, 3.40]) and normative beliefs (OR = 2.09, 95% CI [1.16, 3.76]) were associated with initial use after multiplicity correction. These associations were attenuated and non-significant in the sensitivity cohort. Control beliefs, attitudes, and behavioural intention showed no consistent associations with initial use. No personal determinant was associated with documentation intensity. The nursing practice environment was not independently associated with either outcome. Conclusions: Initial ND use was associated with work exposure and, in the primary cohort, with behavioural and normative beliefs. Baseline individual and organisational factors did not explain documentation intensity, supporting a distinction between initiation and subsequent extent of use.
Background: Missed Nursing Care is a comprehensive, multidimensional, and frequently occurring phenomenon in various clinical contexts in Portugal. Objective: This study aimed to translate, adapt, and cross-culturally validate the MISSCARE Survey-Patient for the Portuguese population and to analyze the quality of its measurement properties. Methods: An exploratory–descriptive, quantitative, cross-sectional validation study was conducted. The questionnaire underwent cross-cultural adaptation through translation, translation synthesis, and back-translation procedures, followed by harmonization by an expert committee, pre-testing, and field testing. Results: Ten hospitalized persons and ten nurses participated in the pre-test as experts, while 135 hospitalized persons were included in the field testing. In the pre-testing, excellent content validity indices were obtained for clarity (S-CVUI/Med of 0.98 and S-CVI/UA of 0.84) and cultural relevance (S-CVUI/Med and S-CVI/UA of 1.00) for the overall instrument. In the field testing, a final three-dimensional model (Basic Care, Communication, and Time to Response) was obtained, explaining 66.7% of the total variance. Evidence based on internal structure was supported by Structural Validity indices from the confirmatory factor analysis [X2(56) = 52.421, p < 0.001, χ2/df = 2.722; PCFI = 0.640 and CFI = 0.892]. Convergent Validity was demonstrated through a moderate correlation between the instrument and a question assessing satisfaction with care (r = −0.677; p < 0.001). For the overall instrument, Cronbach’s α was 0.818, indicating very good Internal Consistency, while values for the dimensions ranged between 0.766 and 0.902. Minimal Important Change exceeded the Smallest Detectable Change by seven points for the total instrument, suggesting good potential to detect meaningful changes. Conclusions: The MISSCARE Survey-Patient-PT demonstrates good measurement properties for assessing hospitalized patients’ perceptions of the occurrence of Missed Nursing Care in Portuguese health services.
Background/Objectives: Chronic diseases place sustained pressure on primary care systems worldwide. While artificial intelligence (AI) shows promise for supporting chronic disease management in primary care, the factors influencing its adoption and implementation have not been comprehensively addressed within the specific context of primary care chronic disease management. The aim of the scoping review was to identify the key drivers that influence AI adoption in primary care settings for chronic disease management. Methods: This scoping review was conducted following the PRISMA ScR guidelines. A comprehensive search of seven databases was conducted between 14 April and 14 May 2025, with an updated search on 27 February 2026 using the same search strategy and eligibility criteria. Eligible studies examined the adoption or implementation of AI for chronic disease management in primary care and were published in English from 2010 to 2026. Data were charted using a standardised extraction tool and synthesised narratively. The protocol for this scoping review was registered with INPLASY. Results: Twenty-two studies were included, identifying five domains influencing AI adoption. Technical factors included data quality, interoperability, and algorithm transparency. Human factors related to clinician trust, workload, digital literacy, and preferences for hybrid human–AI care. Legal and ethical considerations centred on privacy, accountability, fairness, and independent validation. Organisational factors involved leadership, workflow integration, and resourcing, while geographical and cultural contexts shaped readiness, acceptability, and equity. Conclusions: AI adoption in chronic disease management within primary care is shaped by multi-level, context-dependent factors. The findings suggest that implementation may require coordinated strategies encompassing robust data governance and interoperability, clear regulatory frameworks, workforce capability development, workflow-aligned hybrid models with appropriate human oversight, and sustainable resourcing and reimbursement. Future research should extend beyond technical performance to evaluate acceptability, safety, workload, equity, and longer-term organisational impacts.
Background: Entrepreneurship has become an essential competency for healthcare professionals because it promotes innovation, autonomy, and the development of sustainable healthcare services. Although entrepreneurship education has demonstrated positive effects on students’ entrepreneurial knowledge and competencies, evidence regarding its effectiveness among nursing interns remains limited. This study examined changes in nursing interns’ entrepreneurship awareness, entrepreneurial intention, and entrepreneurial characteristics following participation in a structured entrepreneurship training program. Methods: A quasi-experimental one-group pretest–posttest design with a two-month follow-up assessment was conducted among 168 nursing interns at the Faculty of Nursing, Cairo University. Participants completed three researcher-developed instruments assessing entrepreneurship awareness, entrepreneurial intention, and entrepreneurial characteristics. The intervention consisted of a structured entrepreneurship training program delivered through interactive educational strategies, including lectures, group discussions, brainstorming, case-based learning, and practical activities. Data were analyzed using repeated-measures analysis of variance (ANOVA) and Pearson correlation coefficients. Bonferroni-corrected pairwise comparisons were performed following significant overall repeated-measures effects. Results: Entrepreneurship awareness increased significantly across the three assessment periods, with scores increasing from 6.41 ± 3.16 at baseline to 16.99 ± 3.45 immediately after the intervention and remaining significantly higher at the two-month follow-up (14.42 ± 4.01; p < 0.001). Significant improvements were also observed in overall entrepreneurial characteristics (F = 158.08, p < 0.001, ηp2 = 0.49), particularly perseverance, demand for efficiency and quality, commitment to work, information seeking, goal setting, and planning. In contrast, entrepreneurial intention did not change significantly across the three assessment periods (F = 1.22, p = 0.30, ηp2 = 0.01). Entrepreneurship awareness was weakly and positively correlated with entrepreneurial intention across the assessment periods (r = 0.165–0.263, p < 0.05). Conclusions: Participation in the entrepreneurship training program was associated with significant improvements in entrepreneurship awareness and entrepreneurial characteristics among nursing interns, whereas entrepreneurial intention did not demonstrate a statistically significant change. Integrating entrepreneurship education into undergraduate nursing curricula may strengthen innovation-related competencies and prepare future nurses to develop sustainable healthcare initiatives. Future controlled longitudinal studies should investigate the psychological and contextual factors that may influence the development of entrepreneurial intention.
Background/Objectives: Nurses may support offense-related self-reflection through practices that extend beyond formal group programs and dedicated offense-focused interviews; however, the scope of such support remains unclear. In this study, we described the range of nursing practices that nurses in Japanese forensic psychiatric inpatient settings perceived as supporting offense-related self-reflection beyond these formal interventions. Methods: A qualitative descriptive study was conducted using individual semi-structured interviews with 13 nurses from six hospitals between May and November 2025. Japanese-language transcripts were analyzed using inductive qualitative content analysis. Meaning units were coded and iteratively organized into subcategories and categories. Credibility and dependability were strengthened through co-researcher review, reflexive discussion, audit trail, and peer debriefing. Results: Five categories and 15 subcategories were identified: (1) examining offenses, victim impact, and responsibility; (2) clinical and relational readiness for self-reflection; (3) applying reflective insights to recidivism-prevention actions; (4) extending reflective learning into post-discharge life planning; and (5) integrating offense-related understanding into inpatient–community care planning. Conclusions: The categories describe functions that participants attributed to nursing practices surrounding formal interventions; therefore, they should not be interpreted as validated components of self-reflection or as evidence of effectiveness. The findings provide an initial, context-specific framework to guide nursing assessment, care planning, education, and further conceptual and empirical research that includes patients and community providers.
Aim: To evaluate the effect of a student-generated podcast intervention focused on maternal–child health topics on nursing students’ self-perceived knowledge, educational satisfaction, and gameful engagement. Introduction: Health education is essential for promoting healthy lifestyles and preventing disease, making the acquisition of effective communication skills vital for nursing undergraduates. While digital audio media and podcasts are increasingly popular pedagogical tools, traditional applications rely on passive listening. Student-generated podcast production represents an active learning approach that may enhance engagement, communication skills, and content synthesis. Design: Quasi-experimental study without randomization. Methods: The intervention was conducted across a 4-week framework comprising 8 contact hours of faculty guidance alongside independent teamwork. First-year nursing students organized into small collaborative groups (3–4 peers) received initial training on digital audio pedagogy, metadata, and production. Teams developed 5-to-7-min podcast capsules addressing eight evidence-based maternal–child health themes. Faculty provided structured formative checkpoints for script clinical validation and technical audio editing guidance. All completed podcasts were evaluated using a 100-point rubric assessing scientific accuracy (35%), communication clarity (25%), narrative engagement (20%), and technical quality (20%); thirty top-scoring episodes were selected for public radio broadcasting. Pre-and post-intervention self-administered questionnaires measured self-perceived knowledge across all eight topics, educational satisfaction, and gameful experience via the validated 27-item Gameful Experience Scale (GAMEX). Results: A total of 130 valid questionnaires were analysed at each assessment point. Self-perceived knowledge was higher at the post-intervention assessment across all eight topics (all Holm-adjusted p < 0.001). After Holm correction, general podcast satisfaction (adjusted p = 0.036), fulfilment of expectations (adjusted p = 0.036), recommendation to friends or family (adjusted p < 0.001), perceived importance of podcasting for maternal health (adjusted p = 0.036), and perceived ease of setting up a podcast (adjusted p = 0.005) remained statistically significant. Creative Thinking, Mastery, and the overall GAMEX score were nominally higher before multiplicity adjustment, but none remained statistically significant after Holm correction (adjusted p = 0.126, 0.234, and 0.158, respectively). Conclusions: Student-generated podcasting was associated with higher self-perceived knowledge and favourable appraisal on several educational outcomes. GAMEX differences were exploratory after Holm correction.
Background: Generative Artificial Intelligence (GenAI) is increasingly integrated into nursing education, yet structured AI literacy training and ethical guidance remain limited. Consequently, nursing students often rely on informal learning, resulting in variability in AI readiness, confidence, and responsible use. Aims: This study was conducted to examine (1) whether AI literacy was positively associated with AI self-efficacy and AI attitudes and (2) whether AI self-efficacy mediated the relationship between AI literacy and AI attitudes. Methods: A cross-sectional survey using convenience sampling was conducted with 100 prelicensure nursing students in New York City. Data were collected using the AI Literacy Scale (AILS), AI Self-Efficacy Scale (AISES), and Generative AI Attitude Scale (GAIAS). Correlation and path analyses were performed using SPSS and Amos 30.0. Results: The participants had a mean age of 30.25 years, and 71% were women. AI literacy and AI self-efficacy were both positively associated with AI attitudes (all p < 0.001). Path analysis showed that AI literacy significantly predicted AI self-efficacy (β = 0.39, p < 0.001) and AI attitudes (β = 0.28, p = 0.003). AI self-efficacy significantly predicted AI attitudes (β = 0.31, p = 0.001) and partially mediated the relationship between AI literacy and AI attitudes. Conclusions: AI self-efficacy partially mediated the relationship between AI literacy and AI attitudes. Nursing curricula may benefit from structured AI education that integrates guided GenAI practice, case-based learning, and faculty feedback. Such educational frameworks warrant further empirical investigation regarding their potential to foster AI literacy, AI self-efficacy, and positive attitudes toward responsible AI integration, particularly through longitudinal studies assessing subsequent behavioral outcomes.
Background and Objectives: Digitalization studies often emphasize perceived benefits while overlooking professionals who cannot determine whether digital tools are useful. This study quantified digital hesitancy among anesthesia and intensive-care professionals, examined its relationship with professional role and experience, and compared it with reported barriers and technology use. Methods: A single-centre cross-sectional survey included 161 professionals (80.1% of 201 eligible departmental staff): 55 nurses and 106 physicians. A four-item Uncertainty Index measured inability to appraise digital benefits in patient safety, clinical decisions, management, and education. Barrier Burden and Resource-Efficiency indices were also calculated. Group differences were assessed using nonparametric tests, and predictors of high uncertainty were examined by multivariable logistic regression. Results: Nurses had substantially higher uncertainty than physicians (mean Uncertainty Index 1.60 vs. 0.49, difference 1.11, 95% CI 0.80 to 1.42; p < 0.001), particularly regarding educational and clinical benefits. Reported barriers were similar across professional groups, with technical problems being the most common. Any reported prior use of training simulators, irrespective of frequency or recency, was markedly lower among nurses than physicians (1.8% vs. 47.2%; absolute gap 45.4 percentage points, 95% CI 35.2 to 55.5; p < 0.001). After adjustment, physician status remained strongly associated with lower odds of high uncertainty, whereas overall seniority was not significant. In an exploratory within-nurse analysis, uncertainty was higher among more experienced nurses, reaching its highest level among those with more than 20 years of practice (Spearman ρ = 0.49, 95% CI 0.24 to 0.68; p < 0.001); the seniority bands were small (n = 7 to 18), so this gradient is hypothesis-generating. Conclusions: Digital hesitancy was concentrated among nurses and was distinct from shared technical barriers; within nurses it was higher at greater seniority. Because patient-safety outcomes and intervention effects were not measured, targeted simulator-based training and role-specific feedback should be regarded as hypotheses for prospective evaluation alongside, rather than established alternatives to, generic infrastructure improvements.
Background/Objectives: Chronic pain is a prevalent and complex condition associated with substantial physical, psychological, and social burden. Behavioural activation (BA), a structured psychological intervention originally developed for depression, may be relevant to chronic pain through its focus on reducing behavioural avoidance and increasing engagement in meaningful activities. Although BA has been applied in studies involving people with chronic pain, the safety and effectiveness of BA in this population have not been comprehensively synthesised. This systematic review and meta-analysis will examine the safety and effectiveness of BA for people with chronic pain. Methods: A systematic review and meta-analysis of literature evidence will be conducted. This protocol was developed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) and prospectively registered with PROSPERO (CRD420261379007). Randomised controlled trials (RCTs) evaluating BA or BA-based interventions for individuals with chronic pain will be eligible. MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Emcare, Web of Science Core Collection, Scopus and the Cochrane Central Register of Controlled Trials (CENTRAL), trial registries, and citation tracking will be searched. Two reviewers will independently screen records, extract data, and assess risk of bias using the Cochrane Risk of Bias 2 (RoB 2) tool. Where appropriate, meta-analysis will be conducted using a random-effects model. Pain intensity will be the primary outcome. Reported adverse events and other safety outcomes will be extracted and synthesised. Certainty of evidence will be assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Results: Not applicable; this is a protocol. Findings will be synthesised as specified in the Methods. Conclusions: The review will evaluate the effectiveness of BA with respect to pain intensity among people with chronic pain and examine what is known about its safety based on reported adverse events and other safety outcomes in existing trials. The review is expected to clarify the extent, consistency, and certainty of the randomised evidence on the effectiveness and safety of behavioural activation interventions for chronic pain and to identify gaps in adverse-event reporting and safety monitoring. Findings may inform clinical decision-making, intervention adaptation, and future research on BA for chronic pain.
Background/Objectives: Young people’s mental health is increasingly discussed using diagnostic terms. However, limited knowledge exists about how young people describe distress and support needs. This study explored how young people with self-reported functional difficulties described challenges affecting their mental health and everyday lives. Methods: A qualitative study was conducted using 137 anonymized chat and text message contacts from BRIS (Children’s Rights in Society), a Swedish youth helpline. Contacts registered within the category “Functional Impairments” were selected through predefined inclusion criteria. The material was analysed in Swedish using Framework Analysis. Results: One overarching theme, Trying to Survive in an Emotional Storm, was identified, comprising three subthemes: Social Environment—Between Norm Pressure and the Need for Support, A Constant Struggle in the Educational System and Insufficient Parental Support—Between Desire for Help and Barriers to Understanding. Young people described challenges related to social relationships, school demands, and limited support from adults. Self-reported diagnostic labels, particularly ADHD, were used to explain and communicate distress. Conclusions: The findings suggest that distress was closely linked to social and contextual circumstances. For nurses and other mental health professionals, the findings highlight the importance of listening to young people’s narratives and supporting participation, autonomy, and meaning-making.
Background/Objectives: Healthy macrovascular and microvascular circulation is essential for wound prevention and healing in high-risk feet. While validated methods of assessing lower limb macrocirculation exist, microcirculation assessment often relies on subjective clinical judgement. This study aimed to determine reliability and reproducibility of laser speckle contrast imaging (LSCI) of superficial circulation in the feet of adults attending a high-risk foot clinic. LSCI was undertaken on seven regions of the foot, and then repeated 3–5 min later. Methods: LSCI measures were compared to health and clinical measures using correlations, t-tests or ANOVA, as appropriate, and intra-class correlation coefficients (ICC) used to analyse reliability measures. In a sample of 31 participants, good test–retest reliability was found (3–5 min apart), with ICC from 0.94 (95% CI 0.76–0.98) to 0.99 (95% CI 0.96–0.99). Results: A sub-group of 10 participants were available to test reproducibility one week later, with Cronbach’s alpha ranging from 0.83 to 0.97. Lower LSCI perfusion measures were significantly related to longer ulcer duration, use of a walking aid, and presence of respiratory disease or previous cerebro-vascular accident. Conclusions: These findings support the potential role of LSCI as a non-invasive method to evaluate superficial perfusion in high-risk feet.
Background: Falls are the most common hospital-acquired adverse event, leading to extended hospitalization, loss of independence, disability, and premature death. Routine fall risk assessments are time-consuming, even with limited factors. An AI-derived fall prediction model can provide more comprehensive and comparably accurate risk predictions quickly and as often as needed. Objective: To develop and validate a fall prediction model for fall risk in adult inpatients. Methods: Patient records from 2016 were extracted from the adult inpatient database, including information from the Electronic Inpatient Medication Records, SAP, and Hospital Incident Reporting System. The sample consisted of 1506 cases (1:5 faller to non-faller). The fall prediction model was trained using the following four variables: demographics, diagnosis, medications, and surgery. Data sources included the hospital’s data repository, integrating admission/discharge, pharmacy, laboratory, and incident reports. Results: The support vector machine model performed best among all tested models, achieving an AUC of 0.803, recall of 0.816, and precision of 0.440. In the validation cohort (978 patients: 163 fallers and 815 non-fallers), the fall prediction model demonstrated moderate-to-good discrimination (AUC 0.79), with accuracy of 0.67, sensitivity of 0.46, and specificity of 0.86. Compared with the nursing four-item fall risk assessment, which showed lower discrimination (AUC 0.65, accuracy 0.65, sensitivity 0.58, specificity 0.72), the fall prediction model had better specificity and overall discrimination, though the nursing tool was more sensitive in identifying fallers. Conclusions: The fall prediction model using demographics, diagnoses, medication, and surgery data predicts falls risk effectively. It enables timely, accurate risk assessments and supports preventive interventions, saving nurses’ time for direct patient care.
Background: Health innovation education often lacks focus on local realities and practitioner-led approaches. An international Canada-Brazil academic partnership was developed to address this gap within Brazil’s Unified Health System. Objectives: This paper examines attendees’ perceptions of a short-term, binational educational intervention and identifies perceived gaps in innovation training within a resource-constrained health system. Design: A qualitative, pedagogically focused program evaluation of a short-term binational educational intervention, using participant reflections and post-course survey responses to examine perceived learning, applicability, and curricular gaps. Settings: Two academic and clinical sites in Vitória and Salvador, Brazil. Attendees: Fifty attendees (30 in Vitória, 20 in Salvador), comprising students, faculty, and health and social care professionals. Methods: The 30 h in-person course was delivered in late November (Vitória) and early December 2025 (Salvador) and addressed ‘wicked problems’ through value proposition development, design thinking, and prototyping. Facilitated by a Canadian faculty with English–Portuguese simultaneous translation. The course’s immediate evaluation used daily reflective exercises and a final participant survey. Results: Respondents’ reflections suggested a perceived reframing of innovation from a primarily technology-oriented concept toward a human-centered, context-responsive, and systems-oriented process. Respondents also identified areas requiring further curricular attention, including financial sustainability, implementation planning, and impact evaluation. Conclusions: Findings from this immediate post-course evaluation suggest that short-term, interprofessional innovation education may support perceived shifts in how participants understand health innovation. However, because the evaluation relied on self-reported, post-course qualitative data without pre/post or longitudinal measures, findings should be interpreted as perceived learning and exploratory curricular insight rather than demonstrated competency development or sustained implementation capacity.
Background: Over recent decades, Latin America has undergone significant population aging, accompanied by persistent inequalities that adversely affect healthcare access, particularly among Indigenous populations. This scoping review aimed to map and synthesize the available evidence on healthcare access for older Indigenous women in the region, identifying relevant dimensions, barriers, facilitators, and existing knowledge gaps. Methods: A systematic search was performed in scientific databases and gray literature up to 19 June 2026, including studies published between 2020 and 2026 in Spanish, English, or Portuguese. The PCC framework (Population, Concept, Context) was applied. Following a multi-reviewer selection process involving seven reviewers and data extraction using a standardized matrix, the findings were narratively synthesized in accordance with the PRISMA-ScR guidelines. Results: Eleven sources of evidence were included, representing six Latin American countries and including one regional review; qualitative approaches were the most common among the primary studies. Eight dimensions of accessibility were identified: geographic, economic, cultural, organizational, linguistic, functional, administrative, and social. Principal barriers included geographic isolation, poverty, a lack of cultural and linguistic relevance, bureaucratic hurdles, structural racism, and a scarcity of disaggregated data. Facilitators encompassed family and community networks, traditional medicine, local leadership, social programs, and technological/intercultural adaptations such as telemedicine. Compared with the Levesque framework, approachability, appropriateness, and formal system-navigation mechanisms were not clearly represented in the Latin American evidence, while engagement was insufficiently characterized. Conclusions: The findings indicate that structural and cultural barriers continue to persist.
