AIM:Observation requires selective attention to visual information acquired through gaze. Measuring pupil diameter, an index of attention, we examined skilled and novice nurses during the initial assessment of a patient urgently admitted with suspected community-acquired pneumonia. METHODS:This observational study was conducted in a simulated environment. Participants comprised skilled nurses with advanced practice training and novice nurses. During a 120-s initial assessment of a mock patient with suspected community-acquired pneumonia, participants wore eye-tracking equipment. Pupil diameter and gaze transitions were recorded. Changes in pupil diameter were determined by subtracting the baseline value from the measured pupil diameter and compared while participants focused on specific regions such as the face. RESULTS:A total of 16 skilled nurses and 17 novice nurses participated. Novice nurses showed greater negative changes in pupil diameter than skilled nurses when focusing on the facial and chest areas. Mixed-effects modeling showed that, in the later phase of the task, novice nurses exhibited smaller changes in pupil diameter, whereas skilled nurses exhibited slightly larger changes. CONCLUSIONS:Compared with novice nurses, skilled nurses directed their attention more intensively to the face and chest during the initial assessment of a patient with suspected community-acquired pneumonia and impaired respiratory status. They also showed slightly larger changes in pupil diameter in the later phase of the task than novice nurses, suggesting the engagement of selective attention. These findings provide a basis for developing educational materials to train nurses to respond effectively to sudden changes in a patient's condition.
AIM:This study compared changes associated with electronic document-based and video-based education for parents responding to acute illness in young children, focusing on self-reported knowledge, anxiety, and satisfaction. METHODS:A randomized controlled trial with pre- and post-intervention measurements was conducted among 140 adults in Japan who self-reported raising a child under 3 years of age and having experienced their child's acute illness. Participants were assigned to an electronic document group or a video group (n = 70 each). Self-reported knowledge was assessed using a researcher-developed questionnaire, and anxiety was measured using the State-Trait Anxiety Inventory. Pre-post changes and between-group differences in change scores were examined. RESULTS:Total self-reported knowledge scores increased significantly in both groups (p < 0.01), with no significant between-group difference. The video group showed significant improvements in items related to symptoms requiring attention at home and information sources, whereas the electronic document group improved in items related to symptoms requiring medical consultation and emergency calls. State and trait anxiety did not change significantly in either group. Satisfaction was high in both groups. CONCLUSIONS:Both educational formats may support parents' learning about responses to acute illness in young children, although appropriate formats may differ according to the educational content. Information provision alone may have limited effects on anxiety; therefore, future parent education should incorporate interactive and reassurance-focused approaches. TRIAL REGISTRATION:UMIN-CTR: UMIN000056457.
AIM:This study aimed to investigate these aspects in female community-dwelling cancer survivors. METHODS:This secondary analysis of a community-based cancer survey was conducted in Tokyo, Japan. Emotional well-being (EWB) and functional well-being (FWB) were measured using two subdomains of the Functional Assessment of Cancer Therapy-General. The sample comprised 163 survivors of breast and gynecological cancers. We used descriptive statistics and multivariate regression analyses to explore the association between the challenges and EWB and FWB. RESULTS:All participants were women, of whom 118 and 45 were breast and gynecological cancer survivors, respectively. The most frequent challenges experienced but not addressed (referred to as "unaddressed challenges") were "anxieties about progression and prognosis", followed by "balancing hobbies and treatments", and "depressed mood". Although initial analyses suggested that the presence of challenges related to "depressed mood" and "balancing hobbies and treatments" was associated with lower EWB, these associations did not maintain statistical significance after adjusting for multiple testing. Conversely, excluding challenges related to "fertility preservation," all unaddressed challenges related to diagnosis and medical treatment and finances remained robustly associated with lower scores in EWB and FWB. Among unaddressed challenges related to balancing daily life and treatment, "balancing housework and treatment" and "balancing hobbies and treatments" remained associated with lower scores in EWB and FWB. CONCLUSIONS:Female community-dwelling survivors of breast and gynecological cancers face various unaddressed challenges that diminish EWB and FWB. Early identification and targeted public health interventions are required to address survivors' daily life challenges and improve well-being.
AIM:To evaluate the benefits and harms of bathing during the first stage of labor among healthy women with uncomplicated singleton cephalic pregnancies at ≥ 36 weeks' gestation. METHODS:Randomized controlled trials comparing warm-water bathing during the first stage of labor with no bathing were included. MEDLINE (PubMed), Cochrane Database of Systematic Reviews, CENTRAL, and Ichu-shi Web (updated to December 2024) were searched for English- and Japanese-language studies. Two reviewers independently assessed risk of bias using the Cochrane Risk of Bias 1.0 tool, and evidence certainty was appraised with GRADE. Random-effects meta-analyses reported risk ratios (RRs) or mean differences with 95% prediction intervals (PIs), and I2 statistics. RESULTS:Nine studies from eight countries (1994-2018; n = 1823) met inclusion criteria. Bathing did not significantly affect regional analgesia use (RR 0.91, 95% PI 0.82-1.01; I2 = 0%), perineal trauma, spontaneous vaginal birth, intact perineum, caesarean section, abnormal fetal heart rate patterns, neonatal infection, or episiotomy. Instrumental vaginal birth was reduced (RR 0.78, 95% PI 0.61-0.98; I2 = 0%). Satisfaction tended to be higher in the bathing group, though evidence was limited to two small heterogeneous trials. CONCLUSIONS:Evidence certainty was low to very low because of risk of bias, imprecision, lack of blinding, and limited woman-reported outcomes. Bathing appears safe for mothers and infants and may reduce instrumental delivery, but a clear analgesic-sparing effect was not shown. Implementation should ensure tub hygiene, water temperature regulation, and regular maternal and fetal monitoring. TRIAL REGISTRATION:Register name: Effect of Bathing for Pain Relief During the First Stage of Labor: A protocol for a systematic review and meta-analysis. Registration DOI: https://doi.org/10.17605/OSF.IO/J9GTS.
AIM:To describe how experienced psychiatric nurses notice, interpret, and respond to adult inpatients whom they clinically judge to have childhood maltreatment-related attachment difficulties and to clarify the practical reasoning underlying these judgments. METHODS:Eleven experienced psychiatric nurses from two private psychiatric hospitals in Japan were purposively sampled. Participant observation and semi-structured interviews focused on care of adults clinically understood to have childhood maltreatment-related attachment difficulties. Case identification relied on nurses' clinical judgment and routine team discussions or record information; no standardized attachment assessment or independent verification of childhood maltreatment history was used. Data were analyzed using the steps for coding and theorization (SCAT) method. RESULTS:SCAT generated 54 themes or concepts organized into 10 categories and 24 subcategories. Nurses noticed recurrent relational patterns, including distrust, checking behavior, dependency-aggression cycles, misinterpretation of staff intentions, self-harm, and distress around proximity, and adjusted their responses to stabilize the patient-nurse dyad, avoid re-traumatization, support emotional expression, and coordinate team care. Only a limited subset of subcategories was attachment-specific; many others reflected broader psychiatric nursing practices applied through an attachment-informed lens. A trauma-focused noticing process was visible in nurses' attention to nonverbal cues and early behavioral change. CONCLUSIONS:The findings describe situated clinical reasoning rather than a new diagnostic technique or intervention model. Experienced psychiatric nurses adapted everyday psychiatric nursing practices to relational patterns they understood as childhood maltreatment-related and attachment-relevant. The model may inform education, supervision, and future patient-inclusive research.
AIMS:To determine a cutoff score for the Social Connectivity of Mothers with People in the Community Scale (SCMPCS) and revalidate the scale using additional psychosocial indicators. METHODS:A cross-sectional analysis used baseline data from one arm of a randomized trial including 259 mothers with children under 3 years of age in Sapporo City, Japan. Reliability and structural validity were reassessed using Cronbach's alpha and confirmatory factor analysis. Parenting isolation was operationally defined as the absence of support from informal, community-based, and formal sources and used as the reference classification for ROC analysis. Predictive validity was examined using logistic regression adjusted for maternal age, educational attainment, daycare use, and perceived economic status. Criterion-related validity was evaluated using Mann-Whitney U tests. RESULTS:The SCMPCS showed good internal consistency (α = 0.85) and acceptable model fit (CFI = 0.90, RMSEA = 0.073). ROC analysis identified a cutoff of 30 or lower with moderate discriminatory ability (AUC = 0.73; sensitivity = 0.92; specificity = 0.50). Mothers at or below the cutoff had higher odds of meeting the operational reference classification of parenting isolation (OR = 11.94, 95% CI: 2.74-52.03) and reported lower self-efficacy and capacity to receive support, greater loneliness, and poorer well-being. CONCLUSIONS:The SCMPCS demonstrated stable psychometric performance, and the validated cutoff may support broad preventive screening to identify mothers who may need further assessment and early follow-up. Rather than serving as a diagnostic threshold, this cutoff may help maternal and child health services provide timely preventive support.
AIM:To explore the elements of dignity in interaction and the residents' individual dignity from the viewpoint of staff in long-term care facilities. METHODS:In-depth interviews were conducted twice with each participant using a hermeneutic phenomenological approach to understand staff experiences and clarify how they understood the meaning of dignity and dignified care. After theme generation, a panel of seven experts reviewed the themes. The previously established framework of the conceptual matrix derived from the residents' perspective was used to verify the applicability of the result. RESULTS:A total of 18 in-depth interviews were conducted with nine staff who worked at long-term care facilities. Mean age of participants was 36.8 years (SD = 5.9; range: 25-43); six were female (66.7%). A total of 944 codes were extracted from the interviews, and four themes were generated: "dignity in relation to family members, friends, society, and other residents"; "dignified direct care"; "dignified care by nursing care facilities and the nursing care system"; and "(residents') dignity developed over the life course." CONCLUSIONS:Dignity in interaction and the residents' individual dignity are perceived to be important to care staff. Comparing the elements of dignity extracted from interviews of care staff and those of residents, dignified care is defined by staff with more specific behaviors, responsibilities, and relationships. In long-term care, "dignity developed over the life course" is a subjective and unique dignity that is not easily influenced by others or the environment and is the background of dignity in interaction.
AIM:To identify facilitators and barriers to home eating behaviors related to dietary management in patients with heart failure (HF) by comparing patient narratives and healthcare expert (HCE) perspectives against a patient-derived thematic framework. METHODS:We conducted a qualitative descriptive study using semi-structured interviews with patients with HF living at home (or planned discharge home) and HCEs involved in HF/dietary support. Data were collected at two collaborating hospitals in Japan (August 30, 2023 to May 2, 2024). Patient-derived themes/subthemes were developed first, and HCE narratives were then compared and coded against this structure to identify similarities and divergences. RESULTS:Seven patients with HF and six HCEs participated. Qualitative analysis yielded two domains (facilitators and barriers), five themes, and 23 subthemes. Facilitators included "External Support" and "Personal Capability and Internal Motivation" (e.g., family involvement/support, healthcare-provider guidance, and health-aligned home cooking). Barriers clustered into "Intrapersonal Factors," "Interpersonal and Social Factors," and "Contextual and Physical Limitations," capturing psychological burden and preferences, family/social situations, and socioeconomic constraints, and disruptions such as weather/seasonal patterns and fatigue-related limitations. CONCLUSION:The comparison revealed that while patients focused on practical habituation, physical effort, and maintaining interpersonal harmony, experts prioritized nutritional knowledge and broader socioeconomic or clinical risks. To bridge these differing perspectives, future research should focus on developing a brief self-assessment tool that encompasses both patients' lived experiences and expert-identified risks, enabling personalized dietary management tailored to patients' daily realities.
OBJECTIVE:This study aimed to develop and validate the Community Development Competency Scale (ComDe-Scale) for public health nurses (PHNs) working in Community General Support Centers (CGSCs) in Japan. METHOD:A nationwide cross-sectional survey was conducted with all 5495 CGSCs, yielding 1562 valid responses (28.4%). Item analysis, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA) were performed to examine the factor structure, internal consistency, and construct validity. Hypothesis testing included correlations with the Network Establishment Practices Scale (NEPS) and subgroup comparisons by CGSC experience and managerial status. Convergent and discriminant validity were assessed using average variance extracted (AVE), composite reliability (CR), and the Fornell-Larcker criterion. Measurement invariance across management types (direct vs. outsourced) was evaluated through multigroup CFA. RESULTS:The ComDe-Scale demonstrated a three-factor, 20-item structure: (1) Strategic Management for Driving Community Health, (2) Empowerment for Interprofessional and Organizational Collaboration, and (3) Community-Rooted Outreach for Building Networks. Model fit indices indicated a good fit (CFI = 0.955, RMSEA = 0.060). Internal consistency was high (Cronbach's α = 0.845-0.946). All hypotheses for construct validity were supported (p < .001). Convergent validity (AVE = 0.569-0.589, CR = 0.842-0.941) and discriminant validity (√AVE > inter-factor correlations) were confirmed. Partial measurement invariance was observed across management types. CONCLUSIONS:The ComDe-Scale demonstrated satisfactory reliability and validity and can serve as a practical tool for evaluating and strengthening the competencies of PHNs engaged in community development at CGSCs.
OBJECTIVE:This scoping review aimed to map the characteristics of outcomes arising from Community Health Development and Capacity Building in Community Health (CHD/CCH) conducted by public health-related nursing professionals and to identify the types of evidence that inform public health research and practice. METHODS:Following Joanna Briggs Institute methodology and Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines, we systematically searched PubMed, CINAHL, Web of Science Core Collection, and the Cochrane Library. Eligibility was based on the Population-Concept-Context framework: (a) community-dwelling individuals and communities, (b) CHD/CCH activities involving collaborative engagement with residents and stakeholders, and (c) nursing professionals engaged in public health practice. Quantitative, qualitative, mixed-methods studies, and gray literature were included without restrictions on language or publication year. Outcomes were synthesized according to follow-up period (short, mid, long term) and ecological level (micro, meso, macro). RESULTS:Thirty studies published between 1990 and 2024 were included. Of them, 14 used qualitative designs, 13 mixed methods, and 3 quantitative methodologies. Short-term evaluations primarily reported individual and organizational changes, whereas mid- and long-term studies demonstrated more complex, multilevel outcomes such as policy development, strengthened community networks, and enhancements to health and social service systems. Across ecological levels, 14 domains of community capacity were identified. CONCLUSION:Public health-related nursing practice contributes to multilayered community capacity building through CHD/CCH. However, gaps remain in quantitative evaluation and standardized outcome measures, underscoring the need for methodological advancement to reinforce the evidence base for community development in public health nursing.
AIM:The Self-Compassion-Based Childbirth and Parenting Preparation Program (SCPPP) for newly expecting couples is designed to activate self-compassion at challenging moments, induce calm, and enhance co-parenting motivation during the perinatal period. However, how the program affects participants' learning processes remains unknown. This study aimed to clarify the working mechanisms of the SCPPP. METHODS:Between 2022 and 2023, a total of 18 participants (9 couples) were recruited in Japan through obstetric checkups and snowball sampling. They attended 5-week prenatal and 1-day postnatal online programs, wherein they learned about self-compassion and discussed its use with their partners and group members. Their narratives, psychological measurements, and observational data obtained from the online sessions were qualitatively and quantitatively analyzed using a realist evaluation approach. RESULTS:Five prenatal mechanisms were identified: (1) Acknowledge the comfort of learning in a group; (2) Start self-talk; (3) Slow down practices by recalling the safety guidelines; (4) Explore the meaning of learning self-compassion; and (5) Expand self-focused perspectives by listening to partner and group members. Additionally, four postnatal mechanisms were identified: (1) Recall one's trajectory; (2) Incorporate one's learning with the new life through time spent experiencing mutual support within the group; (3) Try to shift the viewpoint from a single-minded focus on childcare; and (4) Make meaning of one's learning experiences. CONCLUSIONS:The findings suggest that the SCPPP may work under mechanisms that follow adult learning and attachment theories, and that these mechanisms may be essential in a self-compassion-based program for expecting couples transitioning to parenthood. REGISTRATION:This study has been registered in the Japan Registry of Clinical Trials (jRCT1030220453).
AIM:This study aimed to elucidate the nature and structure of the decision-making experiences surrounding illness disclosure and concealment among people with epilepsy (PWE) who have experienced generalized tonic-clonic seizures (GTCS). METHODS:Giorgi's descriptive phenomenological method was employed. Data were collected between March and May 2025. A total of eight participants were included in the study. RESULTS:The decision-making experiences of PWE who experience GTCS comprised four essential common constituents: (1) building personal prejudices upon long-standing biases, (2) prioritization of concealing seizures and regaining physical control, (3) realization that unfamiliar realities coexist with ordinary life that must be lived, and (4) classification of relationships through disclosure decisions. CONCLUSIONS:This study offers a new perspective on illness disclosure decision-making among PWE with GTCS, highlighting its existential significance beyond information management. The findings indicate that disclosure or concealment is an ongoing, context-dependent process of relational classification through which participants seek to construct safe and protective social spaces. These decisions imposed a persistent psychological burden that often outweighed seizure symptoms and prompted reflection on identity and perceptions of epilepsy. Overall, the findings underscore the need for nursing care that extends beyond symptom management to support patients' identities, social roles, and disclosure-related decision-making.
AIM:Migraine is a common neurological disorder among healthcare providers; however, there is a lack of specific research focusing on the relationship between overall menstrual health and migraine in this population. This study aimed to investigate the relationship between menstrual problems and migraine among nursing interns, and to explore the mediation effect of sleep quality in this relationship. METHODS:A cross-sectional study was conducted from December 2023 to February 2024; convenience sampling was used to recruit nursing interns from multiple hospitals in Hunan Province, China. Seven indicators of menstrual health, three-item Identify Migraine (ID Migraine), and Pittsburgh Sleep Quality Index (PSQI) were investigated. The association between menstrual health and migraine was analyzed using the logistic regression model. RESULTS:A total of 950 female nursing interns submitted valid questionnaires, among which 190 (20.0%) were screened for migraine, and 196 (20.63%) reported irregular menstrual cycles. In the multivariable model, dysmenorrhea severity, emotional impact, and medical visits were all significantly associated with migraines. After accumulating scores for different dimensions of menstrual problems, the menstrual problem index showed a positive correlation with migraines, and the restricted cubic spline model revealed a linear dose-response relationship between the two. Mediating analysis validated sleep quality partially mediates the association between menstrual health and migraine, accounting for 23.77% of the total effect. CONCLUSION:Our analysis revealed a correlation between higher levels of menstrual problems and an increased prevalence of migraines among female nursing interns, for which sleep quality served as a partial mediator.
AIM:This study aimed to clarify the concept of emotional vitality in community-dwelling older adults and the components that comprise this concept. METHODS:Following the methodology of Rodgers (2000), we organized the components of the concept of "emotional vitality" for older adults living in the community, as documented in each study. Searches were conducted using PubMed, CHINAHL Ultimate, MEDLINE, EBSCOhost, and Japan Medical Abstracts Society (Ichu-shi web). RESULTS:Of the 4105 cases retrieved, nine that met the adoption/exclusion criteria were included in the analysis. Extracted were: (a) five antecedents (striving to be healthy and independent, managing external and internal resources, adapting to vulnerabilities, coping with interpersonal stressors, handling adverse environmental conditions), (b) five attributes (be positive and look ahead, engaging in life, sensing accomplishment, developing healthy boundaries, feel the energy of life), and (c) four consequences (valuing life, continuing to mature, losing the will to live, deprives you of the energy you need to be active). CONCLUSIONS:Gaining emotional vitality from daily life can boost QOL for community-dwelling older adults. Conversely, its absence may lead to inactivity, frailty progression, and depression. Factors like vulnerability and adverse environments impact vitality, emphasizing the need for support in geriatric care to enhance positive experiences and mitigate challenges.
AIM:This study aimed to examine whether home visits by nurses improve the parenting practices of pregnant and postpartum females through a systematic review and meta-analysis. METHODS:We searched PubMed, MEDLINE, Cochrane Library, and Ichushi for randomized controlled trials of regular home visits by nurses or midwives during pregnancy or before the child entered school, published up to March 2023. The primary outcomes were: (1) positive parenting behaviors; (2) negative parenting behaviors; (3) parental confidence; (4) child-parent relationships; and (5) parent-child closeness. We performed random-effects meta-analyses and applied risk of bias assessment and GRADE (Grading of Recommendations, Assessment, Development, and Evaluation)-based evaluation frameworks. The study has been registered in PROSPERO (CRD 42024527084). RESULTS:In total, 1879 articles were screened and eight were included in analyses. The eight articles involved five home visit projects targeting high-risk females and one focused on the general population. Moderate certainty of evidence indicated that nurse home visits increased positive parenting behavior (SMD = 0.16, 95% CI [0.07; 0.26]), decreased negative parenting behavior (SMD = -0.11, 95% CI [-0.21; -0.01]), and had no significant effect on parental confidence (SMD = 0.26, 95% CI [-0.12; 0.64]). No significant intervention effects were observed for child-parent relationships or parent-child closeness, with weak certainty of evidence based on a single article. CONCLUSIONS:Home visits by nurses and midwives increased positive parenting behaviors and decreased negative behaviors. These findings suggest that regular home-visit interventions by nurses are effective in improving the child-rearing behaviors of pregnant and postpartum females.
AIM:This study aims to explore the fundamental structure and essence of the thirst management experiences among patients undergoing hemodialysis. METHODS:Data were collected through in-depth semi-structured interviews with 10 adult patients undergoing hemodialysis. Colaizzi's phenomenological data analysis method was employed to analyze the data. RESULTS:Seventeen themes were derived and organized into five theme clusters: (1) thirst as a physical experience; (2) thirst as a psychological experience; (3) inner conflict and addictive aspects of thirst management; (4) unmet needs in healthcare provider-led thirst management care; and (5) patients' self-directed development of personalized thirst self-management strategies. The fundamental structure and essence of thirst management experiences were captured as "An ongoing dialogue with thirst: navigating the body, mind, and everyday life in the pursuit of quenching thirst." CONCLUSIONS:Thirst is a deeply embodied and psychologically distressing phenomenon among patients undergoing hemodialysis. A holistic and individualized approach is required to support practical thirst management. Nurses should facilitate the development of patient-centered and process-oriented interventions grounded in patients' lived experiences.
AIM:Mental health nurses face numerous work-related stressors that can hinder job performance. Work engagement is critical for enhancing performance. Although emotional intelligence might influence work engagement, the mediating role of patients' positive reactions toward nurses-as perceived by mental health nurses-has not been thoroughly investigated. This study aimed to examine the relationships among emotional intelligence, patients' positive reactions toward nurses, and work engagement in mental health nurses. METHODS:A cross-sectional survey was conducted with 547 mental health nurses from 32 hospitals in Japan. Data on demographics, emotional intelligence, patients' positive reactions toward nurses, and work engagement were collected, followed by mediation analysis using the PROCESS macro. RESULTS:Emotional intelligence was positively associated with patients' positive reactions toward nurses (β = 0.36, p < 0.001). In turn, patients' positive reactions toward nurses were associated with higher work engagement (β = 0.22, p < 0.001). The analysis indicated a significant indirect effect of emotional intelligence on work engagement via patients' positive reactions toward nurses (indirect effect; 95% bootstrap confidence interval: 0.08; [0.05, 0.12]), suggesting that emotionally intelligent nurses perceive more positive reactions from patients, which, in turn, may contribute to their work engagement. CONCLUSIONS:These findings suggest that emotional intelligence may help nurses foster positive and trusting relationships with patients, potentially supporting higher work engagement. The results highlight the importance of providing environments that cultivate emotional intelligence, strengthen interpersonal skills, and encourage the practical development of patient-nurse relationships to enhance well-being and sustained engagement in mental health settings.
AIM:Mothers of infants admitted to neonatal intensive care units (NICUs) often experience significant psychological distress due to various factors associated with their infant's hospitalization. Understanding these stressors is essential for appropriate support in clinical practice. This study aimed to identify the stressors experienced by mothers of infants hospitalized in Japanese NICUs. METHODS:This study employed a purposive sampling approach. First, perinatal medical centers across Japan were approached based on feasibility and relevance to the study aim, and facilities that agreed to participate assisted in distributing recruitment flyers. Semistructured interviews were conducted between November 2024 and March 2025 with 11 mothers of infants hospitalized in the NICU. The narratives obtained from the interviews were transcribed verbatim and analyzed using qualitative inductive analysis. RESULTS:The analysis yielded six categories, 20 subcategories, and 261 codes. These six categories of maternal stressors reflected challenges in maintaining daily life while visiting the NICU, the unit's physical environment, emotional reactions to the infant's condition, restrictions on maternal roles, sources of reassurance within the unit, and stress arising from interactions with healthcare providers. CONCLUSION:Mothers experience stressors not only from the hospital environment and relationships with staff, but also from their infant's presence, indicating that all surroundings can be potential stressors. These stressors arise during visits and in daily life, underscoring the importance of a comprehensive perspective among medical professionals.
