Long-term care (LTC) settings are characterised by organisational complexity and prolonged care trajectories, making nursing clinical governance highly dependent on integrated organisational information systems that support evidence-informed decision-making. Although the nursing practice environment (NPE) is widely recognised as a determinant of care quality and safety, evidence regarding organisational interventions to improve the NPE and inform clinical governance in LTC remains fragmented. To synthesise the available evidence on organisational interventions that promote the quality of the nursing practice environment in long-term care settings. An integrative review was conducted following Whittemore and Knafl’s methodological framework. MEDLINE, CINAHL Complete, and grey literature were searched for studies published between January 2020 and January 2025. Ten studies met the eligibility criteria and were synthesised using an inductive thematic analysis. Four interrelated domains emerged: workforce structure, care processes (including person-centred care, safety culture, digital integration, and missed nursing care), nursing-sensitive outcomes, and organisational value. The evidence consistently suggested that favourable organisational conditions were associated with improvements in care processes and nursing-sensitive outcomes. However, relatively few studies evaluated organisational value longitudinally or examined integrated governance approaches capable of linking these domains. The findings suggest that improving the quality of the NPE in LTC requires integrated organisational interventions that simultaneously address workforce conditions, care processes, nursing-sensitive outcomes, and organisational value. The proposed conceptual framework, derived from the synthesis of the available evidence, may inform clinical governance, nursing leadership, and evidence-informed management. Nevertheless, the limited longitudinal evidence highlights the need for future research to validate integrated governance models and evaluate their impact on organisational performance and quality of care. Not applicable.
Medication dose miscalculations remain one of the most persistent patient safety concerns in clinical practice, while traditional teaching methods often fall short in ensuring proficiency. The integration of artificial intelligence (AI) based learning tools has the potential to enhance knowledge, clinical decision-making (CDM), and self-efficacy among nursing staff. To evaluate the effectiveness of a researcher-developed artificial intelligence-based mobile learning application designed to simulate realistic hospital medication environments with adaptive feedback on nursing’s drug calculation knowledge, decision-making, and self-efficacy, while exploring its feasibility and acceptability in routine training contexts. Mixed-methods study with an embedded design, utilizing two-arm randomized controlled trial for quantitative evaluation and focus group discussions for qualitative exploration. The study was conducted at a non-governmental hospital where 56 nurses, randomly assigned to intervention group (n = 28) or a control group (n = 28). The mobile learning application simulated realistic hospital medication administration scenarios incorporating adaptive corrective feedback and progressively complex drug calculation cases. Data was collected at baseline and post-intervention using a drug dose calculation knowledge assessment, a clinical decision-making scale, and a self-efficacy scale. Post-intervention focus group discussions with the intervention group were analyzed using thematic analysis. The study group achieved significant improvements in knowledge, decision-making, and self-efficacy post-intervention compared to the control group with large effect sizes. Qualitatively, six themes emerged which discussed several aspects of the training such as; perceived clinical benefits, realism, increased nurses’ confidence, ease of use and engagement, training efficiency and challenges and the potential for improvement. This is one of the first randomized controlled trials (RCTs) conducted using mixed-methods and focusing on training nursing staff on drug-dose calculation with artificial intelligence (AI) based simulation. Results indicated that the intervention was associated with significant improvements in the measured outcomes and was perceived positively by the participants. However, its broader implementation across different contexts requires further investigation. ClinicalTrials.gov Identifier: NCT07448259. Retrospectively registered on February 18, 2026. Registration Link: https://clinicaltrials.gov/study/NCT07448259. Manual drug-dose calculation errors and delayed decision-making have been identified as a significant contributors of patient safety risks. Artificial intelligence-based mobile learning intervention improves nurses' drug calculationaccuracy, decision-making speed, and self-efficacy compared to traditional methods. These findings highlight the need for future studies to evaluate the scalability of this training approach and its long-term impact on patient safety and care quality.
Professional autonomy is essential to nursing leadership development in Evidence-Based Quality Improvement (EBQI), yet hospital nurses may struggle to enact this autonomy. This study examined how a participatory learning trajectory influences professional autonomy and nursing leadership development within EBQI practice. A convergent mixed-methods design combined qualitative Participatory Action Research (PAR) with an appreciative approach and a prospective pre-post comparative study. Two nursing teams participated in the PAR trajectory and two served as non-PAR comparison teams. Qualitative and quantitative data were collected and analysed separately and then brought together at the interpretation stage through triangulation, allowing the findings from both approaches to be compared and integrated to provide a comprehensive understanding of the effects of the PAR trajectory. PAR enabled each team to develop a tailored learning trajectory combining reflection, knowledge development, and enactment of nursing leadership behaviours. Four key outcomes emerged: (1) increased professional autonomy, (2) more proactive work practices, (3) enhanced psychological safety, and (4) development of a shared team vision. Compared with non-PAR wards, nurses in participating wards showed significant improvements in aspects of professional leadership (Challenge the Process, p = 0.014), attitudes and skills related to EBQI (p = 0.037), and self-efficacy (p = 0.038). PAR can strengthen professional autonomy and nursing leadership development within EBQI. Ward-based learning, guided reflection, and collective practice appear to be key mechanisms. Sustaining improvements requires ongoing support for practice consolidation and innovation. Transferability may be limited by the Dutch nursing context, where vocationally and bachelor-educated nurses work together in teams with a different skill mix than in other countries. Nursing leadership development should be embedded in everyday clinical practice through structured action-reflection cycles. PAR can foster trust, engagement, and team development, while organizational support is essential for meaningful participation and sustainable impact.
Nurses experience high levels of stress, which can undermine psychological well-being and compromise quality of care. Resilience may be related to these outcomes; however, evidence from Ghana remains limited. This study examined perceived stress, resilience, and psychological well-being among nurses in two Ashanti Region municipalities, and explored their interrelationships and predictors of well-being. A comparative cross-sectional study was conducted among 310 nurses from Mampong (n = 181) and Agona (n = 129) Municipalities. Perceived stress, resilience, and psychological well-being were measured using the PSS-10, CD-RISC-10, and WHO-5 scales, respectively. Sociodemographic and work-related variables were collected using structured questionnaires. Chi-square tests assessed associations between sociodemographic variables, Spearman correlations examined relationships among stress, resilience, and well-being, and multivariable logistic regression identified factors associated with psychological well-being. High stress was more prevalent in Agona (41.9
Nursing students often have limited opportunities to provide end-of-life care during clinical placements. This study aimed to examine changes in objective clinical competence, knowledge, and confidence among undergraduate nursing students following participation in a scalable end-of-life care simulation program incorporating observational learning and structured debriefing. This quasi-experimental one-group pretest–posttest study was conducted at a single national university nursing program in Japan. Third-year students were recruited on a voluntary basis, and 27 of approximately 80 eligible students participated. The 80-min simulation program was adapted from a previously evaluated small-group scenario and redesigned for scalable delivery, in which approximately 25–30 students participated in a single session through direct care roles, structured observation, small-group discussion, and sequential debriefing. Objective clinical competence was evaluated using an objective structured clinical examination (OSCE) at baseline (T0) and 2 weeks later (T2). Knowledge and confidence were assessed at T0, immediately after the program (T1), and T2. Twenty-seven students enrolled in the study, and 25 completed all evaluations. The primary outcome, OSCE-assessed clinical competence, increased for physical assessment skills (3.08 ± 1.50 vs. 5.96 ± 1.17; mean difference 2.88, 95
The nightmares are associated with psychopathological symptoms in the healthcare workers. However, there are few studies conducted on healthcare students as well as on nursing students. The aim of the study was to evaluate type, frequence and components of nightmares in nursing students and compare them with the presence of depression, anxiety, and stress. A total of 234 nursing students were included in the study. For the nightmare assessment, we used the Hamburg Nightmare Questionnaire (HNQ). Whereas for the depression, anxiety and stress symptoms, were evaluated by the Depression, Anxiety, and Stress Scale – 21. We found that 75.3
Medication preparation and dose calculation are critical components of safe medication administration, requiring nursing students to integrate knowledge, skills, and clinical decision-making competencies. Assessing students’ self-efficacy in these processes is important for identifying their educational requirements. Therefore, measurement tools that can comprehensively assess this multidimensional construct are required. This study aimed to develop the Medication Preparation and Calculation Self-Efficacy Scale and examine its psychometric properties to assess nursing students’ self-efficacy regarding the medication preparation and calculation process. This methodological study included 539 nursing students from two universities, with independent samples used for EFA and CFA. The scale items were developed based on a literature review and Bandura’s self-efficacy theory. Content validity was evaluated using the Delphi technique with input from 15 experts in the field. Construct validity was examined using Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA). Convergent and discriminant validity were assessed using Composite Reliability (CR), Average Variance Extracted (AVE), and the Fornell–Larcker criterion. Cronbach’s alpha and intraclass correlation coefficients (ICC) were calculated for reliability analyses. Criterion-related validity was evaluated using a five-item medication calculation test. The content validity index values for the scale ranged from 0.87 to 1.00 at the item level and were 0.97 at the scale level. The EFA revealed a three-factor structure that explained 63.72
In long-term care (LTC) homes, nursing assistants make judgments about the relative importance of diverse care activities within complex organisational and workload contexts. This study aimed to identify their shared perspectives on the relative importance of selected care activities and to explore the reasoning they articulated when explaining these perspectives. Q-methodology was used to investigate nursing assistants’ subjective perspectives. Fifteen nursing assistants from three LTC homes in Shandong Province, China, ranked 25 care-related statements on a forced distribution from least important (− 4) to most important (+ 4). Each Q-sort included a think-aloud task and was followed by a semi-structured interview. Q-sort data were analyzed using centroid factor analysis and varimax rotation in PQMethod, and factor arrays were interpreted with think-aloud data, field notes, and interviews. All 15 Q-sorts were included in the factor analysis. The retained three-factor solution explained 57
The rapid proliferation of artificial intelligence (AI) within nursing has brought convenience to postgraduate nursing students, yet simultaneously raised substantial ethical risks. This study aimed to explore the relationships among AI application challenges, academic integrity awareness, and innovative behaviours among postgraduate nursing students. A cross-sectional study was conducted with a sample of 306 postgraduate nursing students in western China recruited via convenience sampling. Data were collected through the Generative Artificial Intelligence Literacy Questionnaire for Nursing Students, the AI Academic Integrity Awareness Scale, and the Nurse Innovation Behavior Scale. Challenge stressor theory and responsible innovation theory formed an integrated theoretical framework guiding the whole study and the interpretation of all empirical findings. Descriptive statistics, Pearson correlation analysis and multiple linear regression analysis were performed for data analysis, with the statistical significance threshold set at p < 0.05. Mean total scores indicated moderate-to-high levels of AI application challenges (40.71 ± 7.69), academic integrity awareness (34.83 ± 5.89), and innovative behaviours (35.94 ± 6.21) among postgraduate nursing students, with male participants scoring significantly higher on innovative behaviours than females. AI application challenges were significantly and positively correlated with academic integrity awareness (r = 0.419, p < 0.001) and innovative behaviours (r = 0.406, p < 0.001), and academic integrity awareness also showed a significant positive correlation with innovative behaviours (r = 0.501, p < 0.001). Together, these correlated variables explained 31.2
Globally, the nursing industry has never been watered down by challenges related to burnout, job satisfaction and high turnover rates. Healthcare organizations progressively employ strategies to improve nurse engagement in the decision making in the organization. One of these strategies is the Magnet recognition Program established by the American Nurses Credentialing Center which recognizes the institutions that exhibits excellence in the nursing practice and leadership. Despite these recognitions, there is scarcity of research that examined the association of Magnet recognition to the psychological empowerment of the staff compared to non-Magnet hospitals. The finding of this study may contribute insights for the hospital administrators and nursing leaders in strengthening nurses’ involvement in decision making within the organization, specifically supporting the Saudi Vision 2030 through healthcare transformation. This descriptive cross-sectional study research design explored perceived level of shared governance and psychological empowerment among nurses from Magnet and non-Magnet hospitals, as well as the differences between variables. A survey was conducted between March 2026-April 2026. at King Abdulaziz University Hospital (KAUH) and King Abdullah bin Abdulaziz University Hospital (KAAUH) in Riyadh, Saudi Arabia. Convenience sampling will be used to recruit participants. Using the Index of Professional Nursing Governance (IPNG) Tool 3.0 and Psychological Empowerment Indicator (PEI), it was revealed that there was significant difference between the perceived level of shared governance among nurses in the Magnet and non-Magnet hospital. However, an absence in significant difference was noted in terms of psychological empowerment. In conclusion, the findings of this study implies that there is a need to foster a shared governance that improves the involvement of nurses in the organization’s decision-making and continue practicing empowerment strategies.
Evidence-Based Practice (EBP) is essential for enhancing healthcare quality and patient outcomes. Clinical nurses, as the largest professional group in healthcare, play a critical role in translating evidence into practice. In China, ongoing healthcare reforms and the hospital accreditation system have increasingly emphasized evidence-based nursing, yet nurses’ EBP competence remains understudied, particularly in less-developed western regions such as Ningxia. Specifically, the factors associated with nurses’ EBP competence, particularly the combined effects of organizational and psychological factors, remain underexplored. This study aimed to examine the associations among organizational climate, critical thinking, self-efficacy, perceived stress, and EBP competence. A cross-sectional study was conducted from January to February 2026 using convenience sampling. A total of 652 clinical nurses from seven tertiary public hospitals across five cities in Ningxia Hui Autonomous Region, China, were approached, and 616 completed the questionnaires (response rate: 94.48
The integration of artificial intelligence (AI) in healthcare and education underscores the need to understand the experiences of nursing students and faculty. Qualitative perspectives from these groups remain limited despite AI’s growing use in nursing education. To explore nursing students’ and faculty members’ experiences with AI in educational settings using the Technology Acceptance Model (TAM). A descriptive qualitative design was used, following COREQ guidelines. From December 2024 to April 2025, semi-structured interviews took place with 28 participants: 16 nursing students and 12 faculty members from two accredited universities. Data were analysed using deductive and inductive content analysis. Four TAM-aligned categories emerged: perceived ease of use, perceived usefulness, behavioural intention to use, and actual system use. Students and faculty both found AI accessible and valuable. Students used AI primarily for presentations, visual content, and case analysis, while faculty relied on it for course materials, academic writing, and administration. AI was recognized as cognitive, instructional, and psychosocial support, serving as a companion during academic challenges and stress. Participants expressed concerns about reduced critical thinking, misinformation, plagiarism, and unequal access highlighted the importance of AI literacy training and balancing AI with traditional approaches. In nursing education, AI extends beyond cognitive and instructional functions to include emotional and psychosocial dimensions. Effective integration requires structured AI literacy programs, ethical frameworks, and interdisciplinary institutional support. Not applicable.
Open visiting policies (OVPs) in Neonatal Intensive Care Units (NICUs) are increasingly recognized for their benefits in supporting family-centered care, enhancing parent-infant bonding, and improving neonatal outcomes. However, implementation of OVPs remains inconsistent, particularly in the Middle East, due to concerns about workload, infection control, and professional autonomy. Understanding nurses’ beliefs and attitudes is essential to inform policy decisions and practice. This study aimed to assess the beliefs and attitudes of nurses working in NICUs across four hospitals in the Eastern Province of Saudi Arabia regarding the implementation of an open visiting policy and to examine the influence of demographic variables on these beliefs and attitudes. A descriptive cross-sectional, correlational study was conducted among 350 NICU nurses in the Eastern Province of Saudi Arabia using a convenience sampling strategy supplemented by snowball recruitment through professional networks. Data were collected via a structured online questionnaire adapted from the validated Beliefs and Attitudes Toward Visitation in NICU Questionnaire (BAVNIQ). Descriptive statistics and regression analysis were used to analyze the data. The findings revealed that most nurses (80.6
Nursing is a profession that involves providing comprehensive care through continuous interactions and reciprocal relationships with patients. Alexithymia among nurses may impair effective nurse–patient communication and interaction. It may not only compromise the quality of clinical care but also impose considerable physical and psychological burdens on nurses. Therefore, this study aimed to assess the level of alexithymia among clinical nurses and to increase awareness of this issue within the healthcare sector. This systematic review and meta-analysis included observational studies. A systematic literature search was conducted in PubMed, Web of Science, Embase, CINAHL, the Cochrane Library, China National Knowledge Infrastructure (CNKI), the Chinese Biomedical Literature Database (CBM), Wanfang Data, and the Chinese Science and Technology Journal Database (VIP) from database inception through October 31, 2024. The methodological quality of the included studies was assessed using the Agency for Healthcare Research and Quality (AHRQ) tool. Statistical analyses were performed using Stata version 15.1. A total of 22 studies involving 9,135 clinical nurses were included in the meta-analysis, all of which assessed alexithymia using the 20-item Toronto Alexithymia Scale (TAS-20). The included studies had a mean AHRQ quality score of 7.8. Given the heterogeneity across studies, the mean TAS-20 scores and corresponding standard deviations were pooled using a random-effects model. The pooled mean alexithymia score among clinical nurses was 54.50 (95
Artificial intelligence (AI) is transforming healthcare delivery. Limited evidence exists regarding nurses’ knowledge and attitudes towards AI in the English-speaking Caribbean. We assessed the knowledge, attitudes and perceived competency requirements in AI among registered nurses at a national hospital in Antigua. All 179 registered nurses at the hospital were invited to complete a survey collecting data on demographic characteristics, knowledge of AI, sources of AI-related information and perceptions regarding the AI-related competencies that nurses should possess. Five-point Likert-type questions assessed attitudes toward AI use. Cronbach’s alpha measured internal consistency and ordinal logistic regression tested the significance of independent associations with selected attitudes. Differences in perceived AI competency needs between students, practising and nursing faculty were examined using Cochran’s Q and McNemar tests. Eighty-six nurses (response rate 48.1
Emergency nursing requires a high level of professional competencies. However, current emergency nursing training in China lacks adequate theoretical grounding and alignment with nurses’ career development. Based on Kolb’s Experiential Learning Cycle, this study aims to develop a tiered core competencies training framework corresponding to nurses’ professional stages (N1-N4). A mixed-methods research design was employed, incorporating a literature review, semi-structured interviews, and a two-round Delphi expert consultation. A preliminary draft of the training framework was formulated through systematic literature review and semi-structured interviews. Subsequently, 18 experts with over 10 years of emergency nursing experience from four provinces across China were invited to participate in two rounds of the Delphi method. A 5-point Likert scale was used to evaluate the importance of each framework item. Consensus criteria were defined as follows: a mean importance score ≥ 4.0, a coefficient of variation ≤ 0.25, and agreement rate (score ≥ 4) ≥ 75
The Second Victim Phenomenon (SVP) is the psychological trauma that healthcare workers experience due to their negative experiences with patients. Its incidence in nurses is well known, but its quantitative implications on nurse retention and attendance are poorly understood. This systematic review and meta-analysis summarizes the evidence regarding the relationship between SVP and nurse turnover intentions and absenteeism. A systematic search of the PubMed, Embase, CINAHL, Web of Science, and the Cochrane Library (CENTRAL) databases was conducted through April 2026, following PRISMA guidelines. The included studies were cross-sectional studies that investigated the relationship between SVP and turnover intentions or absenteeism among nurses. Two independent reviewers used the Newcastle-Ottawa Scale (NOS) to screen, extract data, and evaluate the quality. Random-effects models were used to pool effect sizes in meta-analyses. Heterogeneity was measured using both the I2 statistic and the Cochran Q test. Subgroup analyses were performed to examine differences across geographic regions, healthcare settings, and study quality. Publication bias was measured using funnel plots and the Egger test. The quality of evidence was determined according to GRADE criteria. A total of 38 cross-sectional studies were included, comprising 22,241 participants in the turnover intention analysis and 14,662 participants in the absenteeism analysis. Meta-analysis revealed that nurses experiencing SVP had significantly higher odds of turnover intention (pooled OR = 2.99, 95
Impression management tactics represent important behavioral strategies through which employees navigate social and organizational interactions, including within healthcare settings. However, the relationship between nurses’ social capital and their use of impression management tactics, as well as the potential variation of this relationship across demographic and structural characteristics, remains insufficiently explored. This study aimed to examine the relationship between social capital and impression management tactics among nurses, and to determine the potential moderating roles of selected demographic and structural variables in this relationship. A cross-sectional survey was conducted among 756 nurses from various healthcare facilities in Türkiye. Data were collected using two self-report scales. Structural Equation Modeling (SEM) and Multi-Group Analysis (MGA) were employed to examine the proposed relationships and moderation hypotheses. Nurses reported moderate levels of social capital (x̄ = 3.344 ± 0.572) and impression management tactics (x̄ = 3.307 ± 0.584). Social capital was positively associated with overall impression management tactics (β = 0.433, p < 0.001), as well as with the self-promotion (β = 0.384, p < 0.001) and defensive (β = 0.411, p < 0.001) sub-dimensions. The strength of these associations differed according to gender, age, and tenure, whereas no significant moderating effects were observed for marital status, education level, income, or institution type. The positive association between social capital and impression management tactics was stronger among male and younger nurses than among female and older nurses. Among tenure groups, the association was strongest among nurses with 1–3 years of tenure (β = 0.566, p < 0.001, R² = 0.320), whereas it was not statistically significant among nurses with more than 12 years of tenure (β = 0.036, p = 0.455, R² = 0.001). Social capital represents an important relational resource associated with nurses’ impression management tactics, with its influence varying across different demographic and structural contexts. These findings extend current understanding of impression management by highlighting the role of interpersonal resources in nursing behavior, suggesting that social capital may complement more traditional explanations emphasizing altruism and adherence to clinical protocols. They also underscore the value of strengthening workplace social capital as a means of fostering constructive professional interactions and provide a foundation for future longitudinal research examining how relational resources shape impression management over time. Not applicable.
Nurses encounter death not only as an integral part of their routine professional responsibilities but, at times, in a far more painful and personal manner through the death of their significant others within the workplace. Such an experience is not merely a clinical event; rather, it is a lived, profoundly existential phenomenon. Understanding the meaning of this phenomenon is essential for developing targeted support mechanisms and improving organizational responsiveness to bereaved nurses. Accordingly, the present study was conducted to explore the meaning of nurses’ lived experiences of the death of significant others in their lives that occurred in their workplace. This qualitative study employed an interpretive phenomenological approach. Nurses who had experienced the death of at least one significant others in their workplace participated in the study. Participants were selected through purposive sampling, and those willing to articulate their lived experiences were invited to take part. Data was generated through in-depth, interactive, semi-structured interviews. Data analysis was performed using Van Manen’s interpretive phenomenological approach. Analysis of interviews with 12 participants (four men and eight women) led to the generation of four main themes and nine subthemes: Endless Suffering (Recurring memories and Immersion in Compounded Grief), Painful Endurance (Pretending to be Fine, Suppressing emotions, Enduring and Carrying On), Failure to Change Fate (Regret and Futile Efforts), and Empathetic Transformation (Identification with Others and Upgrading Sympathy). The findings indicated that the suffering resulting from the loss of significant others in the workplace was experienced as unending by nurses. Emotions such as regret and futile efforts appeared to lead them toward painful endurance and, ultimately, an empathetic transformation.
The present study was conducted to translate and culturally adapt the Motivation for Healing Scale (MHS) for individuals diagnosed with cancer in Türkiye and to examine whether the adapted version demonstrates satisfactory validity and reliability. This methodological study was conducted through face-to-face interviews. The study was carried out in the oncology clinic of a university hospital located in eastern Türkiye. The sample consisted of 202 patients receiving cancer treatment at the oncology clinic. The primary outcomes were the validity and reliability properties of the Turkish version of the Motivation for Healing Scale (MHS), including content validity, construct validity, internal consistency, and test–retest reliability. Secondary outcomes included confirmation of the original factor structure and evaluation of model fit indices. The content validity assessment showed that item-level validity scores ranged between 0.80 and 1.00, while the overall scale validity score was calculated as 0.96. Results from confirmatory factor analysis verified the original 25-item structure consisting of five dimensions. Good model fit was observed based on the fit index values. Reliability analysis demonstrated that Cronbach’s alpha coefficients for the subdimensions fell between 0.778 and 0.909. The reliability coefficient for the complete scale was 0.918, whereas McDonald’s omega was determined to be 0.911. Findings from repeated measurement analysis also indicated that the scale maintained consistency over time. The adapted Turkish form of the Motivation for Healing Scale appears to be a dependable and valid measurement instrument for assessing healing motivation among cancer patients. The scale may support healthcare providers in recognizing patients’ motivational status and designing more individualized care strategies accordingly.
