Introduction: Nomophobia, the fear or anxiety of being without access to a mobile phone, is an emerging behavioural health issue among young adults. Nursing students frequently use smartphones for academic and social purposes, making awareness of nomophobia essential for promoting healthy technology use. Objective: To assess the level of knowledge regarding nomophobia among student nurses and to determine its association with selected socio-demographic variables. Materials and Methods: A descriptive cross-sectional study with an exploratory approach was conducted among 100 B.Sc. Nursing students at a selected college in Thalassery, Kerala. Participants were selected using simple random sampling (lottery method). Data were collected using a structured, self-administered questionnaire consisting of socio-demographic variables and 15 multiple-choice questions assessing knowledge of nomophobia. Each correct response was awarded one mark (total score: 0–15). Content validity was established through expert evaluation (CVI = 0.85), and reliability was confirmed using test–retest and internal consistency methods (Cronbach’s alpha = 0.83). Descriptive and inferential statistics were applied for data analysis. Results: Among the participants, 52% demonstrated good knowledge, 47% had average knowledge, and 1% had poor knowledge regarding nomophobia. Significant associations were found between knowledge level and age (p = 0.002), academic position (p < 0.001), and years of mobile phone usage (p = 0.003). No significant association was observed between knowledge and gender, type of mobile phone used, participation in public seminars, or primary reason for mobile phone use (p > 0.05). Conclusion: Although the majority of nursing students had good knowledge regarding nomophobia, a considerable proportion demonstrated only average awareness. Educational interventions and integration of digital well-being concepts into the nursing curriculum are recommended to enhance knowledge and encourage responsible smartphone use.
Introduction: Diabetes mellitus is a growing worldwide health issue. Nursing students are the future health workforce who should have adequate knowledge and clinical practice skills to manage the disease. In nursing, however, there has been shown to be significant variation in diabetes education programs. Aim: (1) assess perceived and actual diabetes knowledge among nursing students in Pakistan; (2) quantify the discrepancy between self-assessed and objectively measured competence; and (3) identify demographic and educational predictors of both perceived and actual knowledge. Methods: A cross-sectional descriptive study was conducted among 423 nursing students from four nursing colleges in Pakistan from September 2024 to January 2025. A validated questionnaire was used to measure the knowledge and skills of nursing students and consisted of three sections: a) demographic information; b) self-reported knowledge (20 items measured using a 4-point Likert scale); and c) actual knowledge (50 multiple-choice questions). Descriptive, independent t-test, ANOVA, Pearson correlation and multiple linear regression were used for statistical analysis. Results: The mean actual knowledge score was 33.69 ± 7.45 (67.4%). Acute complications and foot care had the highest scores (79.6% and 75.6%, respectively) while the lowest scores were obtained in oral antidiabetic drugs and insulin therapy (53.4% and 62.2%, respectively). The mean self-reported knowledge was 52.34 ± 10.87 (65.4%). They underestimated their knowledge (actual > self by 2.0%, p = 0.01). Actual knowledge predictors were: year of study (internship: β = 5.89, p < 0.001); clinical experience (β = 3.45, p < 0.001); formal training (β = 4.28, p < 0.001); workshop attendance (β = 3.89, p < 0.001); family history of diabetes (β = 1.98, p < 0.001); and self-assessed knowledge (β = 0.21, p < 0.001). The regression model explained 57.2% of the variance (R² = 0.584, adjusted R² = 0.572, p < 0.001). Conclusions: Students demonstrated moderate diabetes knowledge (67.4% correct) but revealed clinically important discrepancies between perceived and actual competence. While 42.1% accurately self-assessed, 21.0% overestimated and 36.9% underestimated their knowledge. The largest knowledge gaps were in pharmacological management (oral antidiabetics: 53.4% correct) and diabetes technologies (continuous glucose monitoring: 31.7% correct). Nursing practitioners should improve diabetes curricula (especially pharmacology and insulin management) and provide supervised clinical experiences to facilitate the students' preparedness to care for people with diabetes.
Introduction: Dance Movement Therapy (DMT), distinct from broader recreational or structured dance activities, has increasingly been proposed as a person-centred, movement-based intervention to address the psychosocial and relational needs of people living with dementia, which are often insufficiently addressed by pharmacological treatments alone. However, the available evidence is characterised by conceptual and methodological heterogeneity, with different dance-based approaches frequently grouped under the same label. A narrative review design was therefore adopted to provide an interpretative and clinically oriented synthesis of how DMT has been conceptualised, implemented, and evaluated across care contexts. Aim: This narrative review aims to critically synthesize how DMT has been described and applied in the literature for people living with dementia and which psychosocial, physical, and cognitive dimensions have been explored. Materials and Methods: A narrative review was conducted using searches in PubMed, CINAHL, APA PsycInfo, and PsycArticles between July 2025 and March 2026, and findings were synthesised with attention to clinical relevance. Results: A total of 11 primary studies were included. DMT for people living with dementia encompasses heterogeneous approaches, ranging from clinical DMT to structured and recreational dance activities, which differ in therapeutic intent and should not be considered equivalent. Overall, the evidence suggests potential multidimensional benefits, particularly in psychological and behavioural domains, including improvements in mood, emotional well-being, and social interaction. Some studies also report gains in mobility, balance, and selected cognitive functions, although findings are inconsistent and often context dependent. Most interventions were conducted in institutional settings, where feasibility was influenced by organisational and logistical factors. The heterogeneity of interventions, study designs, and outcome measures, together with methodological limitations, limits comparability and requires cautious interpretation of the findings. Conclusion: DMT may represent a promising person-centred and relational approach that can enrich dementia care, particularly in institutional settings. However, current evidence remains limited, heterogeneous, and exploratory. Future research should adopt more rigorous designs, clearly distinguish DMT from other dance-based interventions, and include longer follow-up periods.
Introduction: Non-Suicidal Self-Injury (NSSI) has become an increasing mental health concern among adolescents and is strongly associated with negative cognitive–emotional states, particularly hopelessness. Adolescents experiencing hopelessness are more vulnerable to engaging in maladaptive coping behaviors, including self-injury. Objective: This study aimed to examine the relationship between hopelessness and NSSI and to determine the role of hopelessness as a predictor of self-injurious behavior among adolescents. Materials and Methods: This study employed a quantitative cross-sectional design involving 138 senior high school students aged 15–19 years selected using stratified random sampling. Hopelessness was measured using the Beck Hopelessness Scale (BHS), while Non-Suicidal Self-Injury (NSSI) was assessed using the Inventory of Statements About Self-Injury (ISAS). Data were analyzed using Spearman’s rank correlation test to determine the relationship between variables. Results: The findings revealed that most respondents experienced moderate levels of hopelessness (40.6%) and mild levels of NSSI (59.4%). Statistical analysis showed a significant very strong positive correlation between hopelessness and NSSI (r = 0.876; p-value < 0.001), indicating that higher levels of hopelessness were associated with increased frequency and severity of self-injurious behavior. Conclusion: The results indicate that hopelessness plays a significant role in the development of NSSI among adolescents. Adolescents with higher levels of hopelessness tend to have poorer emotional regulation and are more likely to engage in self-injury as a coping mechanism. These findings highlight the importance of early identification of hopelessness in adolescents and the need for targeted mental health nursing interventions to reduce the risk of Non-Suicidal Self-Injury (NSSI).
Introduction: Acid-base balance is one of the most essential physiological terms, which play a crucial role in the examination of the patient and clinical observation. To control the patients well and detect changes when they start to deteriorate, nurses should have a good grasp of acid-base physiology. Objective: The paper examined the impact of the level of knowledge of acid-base balance on clinical surveillance practices of nurses in Northeastern Pakistan. Material & Methods: A cross-sectional, correlational, descriptive study was conducted on 403 registered nurses in different clinical settings in Northeastern Pakistan. The questionnaire was structured and validated, and it was completed by over four weeks by five sections: demographics; acid-base knowledge (10 items); clinical monitoring skills (12 items); knowledge to practice application (5 items); and barriers to effective monitoring. The statistical tests included descriptive statistics, Pearson correlation, independent t tests, one way ANOVA and linear regression. Results: Nurses had high scores on acid-base knowledge (mean of 9.78/10, SD of 0.58) and clinical monitoring skills (mean of 53.8/60, SD of 6.2). There was a great deal of correlation between knowledge and skills (r = 0.82, p = 0.001). Greater qualification, experience, and formal training in ABG was an indicator of superior skills. Heavy workload was the most prevalent (54.1%) and lack of time (36.0%). Knowledge explained 52% of the variance in monitoring skills (R² = 0.52). Conclusion: The clear understanding of acid-base balance is a key to the formation of clinical monitoring skills of nurses. The enhancement of patient monitoring practices will be achieved by the strengthening of acid-base education and barriers of workload.
Introduction: Clinical simulation has become an essential strategy in nursing education, particularly for developing cognitive skills such as situational awareness (SA), which is critical for patient safety and effective clinical decision-making. However, evidence on the impact of simulation on SA among nursing students in Tunisia remains limited. Objective: To evaluate the effect of clinical simulation on the situational awareness of final-year nursing students at the Higher Institute of Nursing Sciences of Tunis. Methods: A quantitative, quasi-experimental, longitudinal study was conducted with 133 final-year nursing students during the academic year 2024–2025. Situational awareness was assessed using an adapted Situation Awareness Global Assessment Technique (SAGAT), measuring perception, comprehension, and projection. Assessments were performed before simulation training and three months after the intervention. Data were analyzed using descriptive statistics and Wilcoxon signed-rank tests. Results: Significant improvements were observed across all dimensions of situational awareness. Mean perception scores increased from 3.75 (SD = 1.25) to 3.98 (SD = 1.19), comprehension from 0.96 (SD = 0.67) to 1.17 (SD = 0.62), and projection from 0.64 (SD = 0.86) to 1.17 (SD = 0.80). The total situational awareness score increased from 5.35 (SD = 1.95) to 6.32 (SD = 1.76). All differences were statistically significant (p < 0.001). Conclusion: Clinical simulation significantly enhances nursing students’ situational awareness, with sustained effects observed three months post-intervention. These findings support the integration of structured simulation-based training into nursing curricula to strengthen cognitive competencies and improve patient safety.
Background: SARS-CoV-2 poses a persistent occupational risk to healthcare workers (HCWs) and, by extension, to health professions students undertaking clinical placements. Undergraduate clinical students represent a bidirectional transmission risk potentially carrying infection between campus and clinical environments, yet their specific infection prevention and control (IPC) practices remain poorly characterised in sub-Saharan African academic settings. This study examined IPC practices among health professions students at the University of Zimbabwe during the active phase of the COVID-19 pandemic. Methods: An analytical cross-sectional survey was conducted between April and July 2021 at the University of Zimbabwe's Faculty of Medicine and Health Sciences. Using convenience lottery sampling, 320 undergraduate health professions students were enrolled. Data were collected via a researcher-administered structured questionnaire the Clinical Student IPC Practices Questionnaire (CSIPQ) comprising 38 items across five domains: (1) hand hygiene, (2) medical mask use, (3) personal protective equipment (PPE) use, (4) scrubs and clinical wear management, and (5) community IPC conduct. The manuscript was prepared in accordance with the STROBE Statement checklist for cross-sectional observational studies. Results: The cohort comprised 320 frontline clinical students, predominantly young adults aged 20-25 years (95.3%) with a male preponderance (65.0%). Participants were drawn from five clinical programmes, with Medicine and Surgery (35.6%) and Nursing Science (28.8%) representing the largest groups, and half were in their fourth year of study, indicating advanced clinical exposure. The prevalence of optimal IPC practice was critically low across all clinical domains: medical mask use (0.6%), PPE use (0.3%), and handwashing (15.3%). Significant associations were observed between handwashing and degree programme (p=0.002) and age (p<.0001). No significant demographic or academic associations were identified for mask use or PPE use, indicating that deficits were uniformly distributed across the cohort. Conclusion: While specific student demographics were associated with better hand hygiene, near-universal gaps in PPE and medical mask use indicate a systemic failure transcending individual characteristics. Transformative, competency-based IPC education, resource security, and institutional safety culture reform are urgently needed to protect future health professionals and their patients.
Background: Soft skills underpin safe, patient-centered nursing care, yet empirical evidence describing these competencies in Moroccan provincial hospitals remains limited. Objective: To assess soft skills levels among nurses, midwives, and health technicians at Hassan I Provincial Hospital (Tiznit, Morocco) and examine associations with sociodemographic and professional characteristics. Results: In a census-based cross-sectional survey (15 May–3 June 2023), 77 of 113 eligible staff participated (response rate: 68.1%). Soft skills were measured using an adapted 25-item Soft Skills Questionnaire (5-point Likert scale; overall Cronbach’s α = 0.90) covering communication, emotional intelligence, management, and confidentiality. The mean overall soft skills score was 79.05 (SD = 8.69) on a 25–125 scale (scale midpoint: 75; observed range: 58–102). Communication was the strongest domain (mean = 48.52/60), whereas emotional intelligence was the lowest (mean = 8.48/15). Confidentiality showed notable gaps (mean = 16.83/30), with 31.2% reporting occasional unsafe handling of patient files. Bivariate analyses comparing low/medium/high soft skills categories did not show statistically significant differences across participant characteristics (all p > 0.05), although descriptive patterns were observed. In multivariable linear regression (outcome: overall soft skills score), higher scores were independently associated with prior soft skills training (B = 4.80; p = 0.001), greater professional experience (B = 0.45; p = 0.048), and working in departments other than the medical unit (B = 3.25; p = 0.021), while night work was associated with lower scores (B = −2.10; p = 0.034) (adjusted R² = 0.42; model p < 0.001). Conclusion: Overall soft skills scores were slightly above the scale midpoint, with strengths in communication but weaknesses in emotional intelligence and confidentiality practices. Structured continuing professional development—especially targeted soft skills training—along with supportive organizational measures may strengthen non-technical competencies and improve quality of care in Moroccan provincial hospitals.
Introduction: The launch of the robotic surgery program in our hospital showed that the main challenges did not concern the technology itself but rather the organization of work. Delays in operating room preparation, unclear task distribution, fragmented communication among professionals, and inconsistent management of instrument traceability highlighted the absence of a clearly defined coordination function. Methods: Through descriptive observations drawn from daily activity during the initial phases of the program, operational episodes, team dynamics, and workflow patterns were recorded in order to understand how the system adapted to the introduction of the robotic platform. Results: From these observations, the figure of the “Da Vinci Coordinator” (DVC) emerged locally as a practical response to organizational challenges. This function contributed to aligning tasks among teams, making workflow preparation more predictable, improving interprofessional communication, and supporting internal training activities. The few descriptive indicators included served solely to contextualize the experience. Conclusion: The DVC function was not conceived as a formalized or generalizable professional role, but rather as an emergent organizational adaptation useful during the implementation phase of a robotic program. The considerations presented may offer insights for other centers preparing to introduce robotic surgery; however, further structured studies will be necessary to assess its transferability to different contexts.
Introduction: Clinical mentoring is essential for nursing education. It facilitates the integration of theory and practice, while promoting the development of clinical, communication, and interpersonal skills. It is becoming increasingly evident that tutors are facing a number of challenges. These challenges are related to the cultural diversity of students and constantly evolving clinical contexts. Despite the emphasis placed on the significance of general and cultural competencies in mentors within the context of international literature, a paucity of studies in Italy exists that evaluate both dimensions employing standardised and validated tools. Objective: This protocol describes a nationwide survey that will assess the mentoring and cultural competencies of Italian nursing tutors. Methods: The study adopts a descriptive cross-sectional observational design, with convenience sampling of approximately 600 tutors active in the academic year 2024–2025. The collection of data will be conducted between July and December 2025 through the utilisation of digital questionnaires. The survey employs two instruments, namely the Mentors' Competence Instrument (MCI) and the Mentors' Cultural Competence Instrument (MCCI), in order to assess these competencies. The MCI has been developed to measure tutors' general skills, including pedagogical, relational and feedback dimensions, while the MCCI has been developed to assess cultural skills and intercultural communication. The collection of sociodemographic data, contextual information and open-ended responses pertaining to the strengths and weaknesses of the tutorial role will also be undertaken. Statistical procedures will include descriptive analyses, using tables and plots to represent the data, as well as inferential analyses such as the Chi-square test, t-test, ANOVA test, Mann–Whitney U test, Kruskal–Wallis test, and correlation analysis. All statistical tests with p < 0.05 will be considered statistically significant. Results: The results of the study will inform the development of targeted training interventions and organisational strategies to enhance the role of the clinical tutor. Conclusions: The survey will contribute to the enhancement of mentoring quality and the professional development of tutors, thereby facilitating the strengthening of the effectiveness of clinical training programmes in Italy.
Introduction: Nurse performance is vital to patient safety and organizational effectiveness. Leadership style is a recognized determinant of performance, influencing consistency, adaptability, and professional growth. Understanding these dynamics is particularly important in multicultural healthcare environments. Objective: This study explored the impact of nurse manager leadership styles on nurses’ job performance at Hamad Medical Corporation (HMC). Methods: A cross-sectional survey was conducted with 980 registered nurses recruited through random sampling. Data were collected using a structured questionnaire including socio-demographic characteristics, the Multifactor Leadership Questionnaire (MLQ-5X), and the Nursing Performance Instrument (NPI). Data analysis was performed using SPSS version 26, applying descriptive statistics, and Spearman’s correlation, Mann–Whitney U, and Kruskal–Wallis H tests. Results: The workforce was predominantly female (72.1%), married (83.7%), and expatriate, with a mean age of 40.4 years. Transactional leadership (2.57 ±085) was the most common style, followed by transformational (2.20±1.05), while passive-avoidant leadership was minimal (1.49±0.97). Transformational leadership demonstrated strong positive associations with consistency of practice and adaptability. Transactional leadership supported compliance but was less effective in stimulating innovation, while passive-avoidant leadership was negatively correlated with performance outcomes. Conclusion: Transformational leadership emerged as the most effective style for enhancing nurse performance, while transactional leadership sustained compliance without fostering long-term growth. Strengthening transformational leadership among nurse managers at HMC may improve clinical outcomes, adaptability, and organizational performance.
Introduction: The increasing prevalence of diabetes is a global public health concern, with foot ulcer prevention techniques, low self-care knowledge, and a lack of confidence contributing to complications like foot ulcers. Methods: This cross-sectional study, conducted between January and December 2022, evaluated foot self-care knowledge, self-efficacy, and self-care behaviors among individuals with diabetes attending public tertiary hospitals in Abeokuta, Nigeria. Data from randomly selected 120 out-patients was collected using a multidimensional questionnaire, and multiple regression analysis was used to assess associations between variables. Results: It was found that participants’ mean age was 44.8±14.65 years. Majority (58.3%) of them did not attend foot self-care education classes and had received a type-2 diabetes diagnosis within the previous 24 months. Many of the patients had low knowledge of foot self-care (55%), low self-care efficacy (55%) and poor self-care behavior (55%). Poor self-care behavior was predicted by low efficaciousness (p<0.0001) and low knowledge of foot self-care (p<0.0001). Conclusion: The study concluded that the extent of knowledge significantly influenced self-care behaviors and the efficacy of foot self-care in averting diabetic foot ulcers. Improving these behaviors requires teaching appropriate knowledge through hands-on self-care treatments and gaining support from policymakers for its sustainability.
Introduction: Job satisfaction is a key determinant of nurse retention, morale, and quality of care. Leadership styles directly shape satisfaction by influencing recognition, autonomy, and support within clinical environments. In Qatar’s multicultural nursing workforce, understanding these dynamics is critical. Objective: This study investigated the relationship between nurse manager leadership styles and nurses’ job satisfaction at Hamad Medical Corporation (HMC). Method: A cross-sectional survey was conducted with 980 registered nurses recruited through simple random sampling. Data were collected using a structured online questionnaire incorporating socio-demographic data, the Multifactor Leadership Questionnaire (MLQ-5X), and the Minnesota Satisfaction Questionnaire – Short Form (MSQ). Descriptive and inferential statistics, including Spearman’s correlation, Mann–Whitney U, and Kruskal–Wallis H tests, were employed. Results: The sample was predominantly female (72.1%) and expatriate, with Indian (42.1%) and Filipino (33.9%) nurses forming the largest groups. Transactional leadership (mean = 2.57) was more common than transformational leadership (mean = 2.20). Overall satisfaction levels were moderate. Transformational leadership showed a strong positive correlation with both intrinsic satisfaction (rho = 0.66, p < 0.001) and extrinsic satisfaction (rho = 0.79, p < 0.001), yielding an overall significant relationship with total job satisfaction (rho = 0.73, p < 0.001).Transactional leadership demonstrated a weak to moderate positive correlation (rho = 0.30, p < 0.001), while passive-avoidant leadership showed no meaningful association with satisfaction (rho = 0.06, p = 0.041). Conclusion: Transformational leadership has the strongest influence on job satisfaction, while transactional and passive-avoidant styles limit long-term fulfillment. Enhancing transformational leadership at HMC may improve satisfaction, retention, and workforce stability.
Introduction: Spiritual care is essential in holistic nursing; however, nursing students often feel less confident and reflective in providing it. Innovative teaching methods combining active learning and reflection are needed to fill this gap. Objective: This study evaluated the impact of reflective, flipped-classroom spiritual care training on students' self-efficacy and reflective thinking. Methods: A quasi-experimental pretest–posttest design with a control group was conducted among 82 undergraduate nursing students from two universities in Indonesia. Participants were allocated to an intervention group (n = 41) or a control group (n = 41) based on existing class enrollment. The intervention consisted of a 16-week reflective flipped classroom supported by an interactive e-module, while the control group received conventional lecture-based instruction. Self-efficacy and reflective thinking were measured at baseline and post-intervention. Data normality was assessed using the Shapiro–Wilk test. Within-group differences were analyzed using the Wilcoxon signed-rank test or paired sample t-test as appropriate, and between-group differences were examined using the Mann–Whitney U test. Results: Within-group analyses showed statistically significant improvements in self-efficacy and reflective thinking in the intervention group (p < 0.001). In the control group, changes in reflective thinking were not statistically significant (p = 0.062). Between-group post-test comparisons demonstrated significantly higher self-efficacy and reflective thinking scores in the intervention group than in the control group (p < 0.001), with a large effect (r = 0.67 for self-efficacy and r = 0.61 for reflective thinking). Conclusion: The findings indicate that a reflective flipped classroom approach is associated with higher self-efficacy and reflective thinking among nursing students in spiritual care education. While causal conclusions cannot be drawn, the results support the educational value of reflective and interactive learning strategies in undergraduate nursing curricula.
Introduction: Autism spectrum disorders (ASD) represent a constantly evolving neurodevelopmental condition that requires specific preparation by the entire multidisciplinary team. However, multiple scientific evidences report little training on ASD in nursing degree courses. The study above aims to assess the level of theoretical knowledge of Italian students regarding autism in pediatric age. Materials and Methods: A multicenter cross-sectional study was conducted on 104 students enrolled in the Nursing degree programme, regularly enrolled in the 2nd and 3rd years of the course at different Italian universities, with or without previous experience in pediatric or mental health services. Knowledge was assessed by administering a validated questionnaire, the Knowledge About Childhood Autism Among Healthcare Workers (KCAHW). Sociodemographic variables and information on training and placement experience with children with ASD were collected. Data were analysed using descriptive and inferential statistics. Results: The average score obtained on the KCAHW was 9.5 out of 19 (SD = 2.78), indicating an insufficient level of knowledge. Scores were significantly higher among students with direct experience with children with ASD (median: 11.0 vs. 9.3; p=0.015) and among female students than male students (mean: 9.9 vs. 8.7; p=0.016). Theoretical training and age were not significantly different. Discussion: The results indicate the existence of a vital training gap. Direct clinical experience proves to be decisive in the improvement of theoretical knowledge. Integrating compulsory modules and structured ASD training in nursing education is recommended to ensure competent, small patient-centred care.
Introduction: Although evidence-based practice (EBP) is a core nursing competency, little is known about the extent to which nurses are educated on the five steps of EBP, including the specific educational content within each step, in pre-licensure and in-service education, and how these educational experiences relate to their knowledge and skills. Objectives: To examine the extent of nurses’ experience of receiving specific educational content related to each step of EBP in pre-licensure and in-service education, and to evaluate the associations between these experiences and EBP knowledge and skills. Methods: This cross-sectional questionnaire survey was conducted between June and September 2022 among 2,672 employed hospital nurses in Japan. EBP knowledge and skills were measured using the Japanese version of the EBP Questionnaire. Experience of receiving EBP education in pre-licensure and in-service education was assessed using items developed from EBP textbooks and core competency literature. Analysis of covariance and relative importance analysis were conducted to evaluate the association between the experience of receiving EBP education and EBP knowledge and skills. Results: 718 nurses (26.9%) were included in the final analysis. The findings showed that nurses’ experience of receiving EBP education was generally limited, with fewer than 25% having learned any EBP-education item, except literature databases, in pre-licensure education. Similarly, fewer than 25% have learned each EBP-education item in in-service education. The adjusted mean EBP knowledge and skills score increased progressively with the extent of education received across the five steps of EBP (20.6 for no steps to 35.5 for five steps), showing a consistent dose–response relationship (p for trend < 0.001). Relative importance analysis showed that the Step 4 and Step 5 items were placed toward the upper end of the contribution rankings. Conclusions: To effectively improve nurses’ EBP knowledge and skills, providing a practical, EBP-specific program that comprehensively covers all five EBP steps would be essential. Additionally, developing programs for training educators would also be essential.
Introduction: Cryptic pregnancy, or the delayed recognition of pregnancy until late gestation, poses unique psychological challenges for mothers due to the lack of prenatal preparation and sudden transition to motherhood. These circumstances may increase the risk of postpartum depression. Protective factors such as maternal self-efficacy and family support are believed to play an important role in reducing depressive symptoms after childbirth. Objective: The purpose of this study is (1) to analyze the relationship between maternal self-efficacy and postpartum depression among mothers with a history of cryptic pregnancy, (2) to analyze the relationship between family support and postpartum depression, and (3) to assess the extent to which maternal self-efficacy and family support predict postpartum depression levels. Materials and Methods: A cross-sectional study was conducted in Jombang Regency, East Java, Indonesia, from May to August 2025, involving 104 mothers with a history of cryptic pregnancy recruited by non-probability snowball sampling. Maternal self-efficacy was assessed using the 15-item questionnaire developed by Witungga et al. (2024; α = 0.916), family support with the 14-item questionnaire by the same authors (α = 0.836), and postpartum depression with the Edinburgh Postnatal Depression Scale (EPDS; Adli, 2022). Data were analyzed using Spearman’s rank correlation and ordinal logistic regression. Results: Most respondents had moderate self-efficacy (72.1%), fair family support (65.4%), and no signs of postpartum depression (68.3%). Spearman’s correlation showed significant negative associations between self-efficacy (ρ = –0.426, p = 0.001) and family support (ρ = –0.398, p = 0.002) with postpartum depression. Multivariate ordinal logistic regression indicated that both self-efficacy (B = –0.462, p = 0.014, OR = 0.63, 95% CI = 0.44–0.91) and family support (B = –0.518, p = 0.012, OR = 0.60, 95% CI = 0.40–0.89) were significant protective factors, jointly explaining 28.9% of variance in postpartum depression (Nagelkerke R² = 0.289). Conclusion: Maternal self-efficacy and family support are significant protective factors against postpartum depression in mothers with cryptic pregnancy. Strengthening maternal confidence and empowering family support systems are essential strategies to mitigate depressive symptoms in this vulnerable group.
Introduction: Peripheral intravenous catheter (PIVC) insertion is a common clinical procedure, yet achieving successful venous access, particularly at the first attempt, remains a significant challenge. Techniques such as tapping and massage have been proposed to enhance venous dilation and facilitate cannulation. Objective: This study aims to evaluate and compare the effectiveness of tapping and massage each compared to tourniquet-only application, in promoting peripheral venous dilation. Materials and Methods: This study is a systematic review conducted following the PRISMA 2020 guidelines. A systematic search was conducted in PubMed, Scopus, MEDLINE, and CINAHL. All databases were accessed in April 2025 to retrieve studies published between January 2015 and April 2025. Studies were eligible if they involved adult participants, compared tapping and/or massage with standard tourniquet application or control, and reported outcomes related to vein diameter, cross-sectional area, or palpability. Quality assessment was performed using the NIH Quality Assessment Tool and for the risk of bias was used the ROBINS-I. Results: Tapping was associated with modest improvements in vein diameter and palpability in some studies, but not in others. Massage showed improvements in palpability, yet no clear advantage over tapping was consistently demonstrated. No clear clinical advantage of one technique over the other was consistently demonstrated, and no study assessed outcomes such as first-attempt success rate. Methodological limitations included small sample sizes, and lack of randomization. Conclusions: Both tapping and massage may promote venous dilation in young, healthy adults, but the evidence is limited. The generalizability of these findings to broader clinical populations, including elderly patients and those with difficult venous access, is uncertain. High-quality studies involving diverse populations and standardized outcome measures are needed to establish the effectiveness of these techniques in routine clinical practice.
Introduction: Physical assessment is a fundamental clinical skill in nursing practice and crucial to developing effective nursing care plans. Thus, acquiring knowledge and skills in physical assessment is an essential competence for undergraduate nursing students. Objective: This study aimed to investigate the effect of utilizing pre-assignment work and presenting specific cues about a case on the clinical reasoning skills of undergraduate nursing students by comparing an intervention group that received specific cues with a control group that did not. Materials: This randomized controlled trial involved second-year undergraduate nursing students. Participants were randomly assigned to an intervention or control group. Both groups completed a pre-assignment related to heart failure and participated in a 60-minute group case study session. The intervention group received specific cues related to the case during the session, guiding their assessment and care planning. Clinical reasoning skills were evaluated subjectively using the Clinical Reasoning Skills Self-Assessment Scale (CRSS) and objectively by analyzing the students’ responses to the group task. Results: A total of 94 participants were randomly assigned to either the intervention group (n= 47) or the control group (n= 47). While the pre-session CRSS scores were similar between groups, the post-session scores on several items related to information gathering, interpretation, problem identification, and goal setting were significantly higher in the intervention group. Qualitative analysis of narrative responses revealed that the intervention group provided more specific and patient-centered nursing care plans based on the patient's symptoms, whereas the control group offered more generalized interventions. Conclusion: The use of pre-assignment and specific cues enhanced students’ ability to interpret patient information and formulate individualized nursing care plans. This approach effectively improved clinical reasoning skills in physical assessment and may serve as a practical alternative in educational settings lacking simulation-based resources.
Introduction: A laparotomy is a surgical procedure involving an abdominal incision to access the peritoneal cavity, commonly performed for diagnostic and therapeutic purposes, including trauma management and the treatment of gynecological, pelvic, and abdominal conditions. In this context, negative pressure wound therapy (NPWT) serves as an effective adjunct to wound management by applying subatmospheric pressure to the wound bed, thereby promoting granulation tissue formation and reducing local inflammation. Objective: This systematic review will aim to evaluate the efficacy of NPWT compared to standard wound care in adult patients undergoing laparotomy, with specific attention to key clinical outcomes such as wound healing time, surgical site infection rates, wound dehiscence, and overall complication rates. Materials and methods: The systematic review follows the PRISMA guidelines and uses the PICO framework for search terms. The studies will be identified through important databases (PubMed, Scopus, CINAHL and Web of Science). Methodological quality and risk of bias will be assessed with JBI critical assessment tools. This protocol for a systematic review has been registered on PROSPERO (N. CRD420251058825). Results: The results of the systematic search and selection process will be reported using a PRISMA flowchart. The extracted data will include wound healing time, granulation tissue development, infection rates, and adverse events. The quantitative synthesis will be conducted if the homogeneity of the data allows it. Conclusions: This systematic review will synthesize the available evidence on the efficacy of NPWT in the management of laparotomy wounds. The findings will have implications for clinical practice in surgical wound care and may contribute to the development of standardized wound management protocols.
