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.
Leisure time activities are recognized as important contributors to psychological well-being and life satisfaction. Nursing students, due to intensive academic and clinical demands, may experience high levels of stress that restrict their participation in leisure activities. However, evidence regarding how leisure time management relates to happiness among nursing students, particularly in multicenter contexts, remains limited. This study aimed to examine the association between leisure time management and happiness among nursing students. This cross-sectional descriptive and correlational multicenter study was conducted with nursing students from four universities in Türkiye in 2025. The study population consisted of 2,097 students, and the sample included 889 participants recruited through convenience sampling via an online survey (response rate: 42.4
Frontline healthcare professionals, especially nurses, are often the main providers of psychological first aid in conflict settings, offering supportive communication, grief support, and trauma-informed care. However, despite its recognized importance in emergency response, PFA capacity remains limited in many conflict-affected countries. This study aimed to assess PFA knowledge and self-perceived competence among novice nurses in delivering PFA during armed conflict across multiple Middle Eastern countries. A multi-country analytical cross-sectional survey was conducted using convenience sampling. The participants were 465 novice nurses, comprising nursing interns and early-career nurses with less than one year of clinical experience, from six Middle Eastern countries: Iraq, Syria, Yemen, Palestine, Saudi Arabia, and Lebanon. Data was collected using a PFA knowledge and competency questionnaire adapted from the WHO Psychological First Aid: Facilitator’s Manual for Orienting Field Workers. Possible scores ranged from 0 to 15 for PFA knowledge and from 1 to 5 for self-perceived PFA competence. Independent sample t-tests, one-way ANOVA, and Chi-square were used to analyze the data. The overall mean self-perceived PFA competence score was 3.52 ± 0.70 out of 5, while the overall mean PFA knowledge score was 7.61 ± 1.75 out of 15. Self-perceived PFA competence differed significantly across countries (F = 7.083, p < .001, η² = 0.072). Participants from Palestine (M = 3.83, SD = 0.64) and Syria (M = 3.76, SD = 0.69) reported the highest competence scores, whereas those from Lebanon (M = 3.26, SD = 0.56) and Saudi Arabia (M = 3.18, SD = 0.66) reported the lowest. PFA knowledge scores differed across countries in the omnibus analysis (F = 2.850, p = .018, η² = 0.037), with the highest mean observed in Palestine (M = 8.25, SD = 1.68) and the lowest in Saudi Arabia (M = 7.00, SD = 2.14). However, no Bonferroni-adjusted pairwise country comparison remained statistically significant in the adjusted model. The mean PFA knowledge score among novice nurses was 7.61 out of 15, and self-perceived PFA competence varied across the participating countries. Due to the low KR-20 value, knowledge findings were interpreted primarily at the item level. The identified item-level knowledge gaps and country-level variation in self-perceived competence support the further development and evaluation of PFA education for novice nurses in conflict-affected settings.
Evidence-Based Practice (EBP) is essential for healthcare quality, yet a gap between research and clinical application persists. University education plays a central role in developing EBP competence among nursing students and helping to bridge this gap. However, comparative evidence on how these competencies vary across institutions with different curricular and regulatory contexts remains limited. To determine overall EBP competence and its dimensions —knowledge, skills, and attitudes— among nursing students at three public universities in Spain and Chile, examining differences across institutional contexts. A multicentre cross-sectional study was conducted during the 2024/2025 academic year at the Universidad de Alicante (Spain), Universitat Jaume I (Spain), and the Universidad de Valparaíso (Chile). EBP competence was assessed using the validated EBP-COQ questionnaire via the REDCap platform. Statistical analysis included bivariate inferential tests and multiple linear regression analysis. Of 1,788 eligible students, 1,035 were included in the final analysis (response rate: 57.9
Implantable cardioverter defibrillators (ICDs) are globally utilized devices to prevent sudden cardiac death by detecting and terminating life-threatening ventricular arrhythmias. Despite their life-saving benefits, many patients experience psychological challenges and difficulties adapting to the device. Low self-efficacy may reduce patients’ confidence in managing ICD-related challenges and adapting to life with the device. This study aimed to develop an evidence-based ICD nursing guideline and to evaluate patient outcomes associated with a guideline-based nursing intervention, particularly self-efficacy and device acceptance, among ICD candidates during the pre- and early post-implantation periods. A quasi-experimental study was conducted with 60 ICD candidates (30 in the control group, 30 in the intervention group) recruited between August 16, 2021, and November 17, 2022. An evidence-based ICD nursing guideline, together with supporting tools, was developed using the ADAPTE methodology and implemented using the Johns Hopkins Nursing Evidence-Based Practice Model. The control group was recruited first and received routine care, followed by the intervention group, which received guideline-based nursing care during the pre- and post-implantation periods. Data normality was assessed using the Shapiro–Wilk test. Depending on data distribution and variable type, Fisher’s exact test, Yates’ corrected chi-square test, Student’s t-test, and the Mann–Whitney U test were used for statistical comparisons. Significant between-group differences were observed in several patient outcomes. On Days 7 and 30, device acceptance and ICD-related self-efficacy were higher in the intervention group, while device-related distress and body image concerns were lower (p < 0.001). ICD-related outcome expectations were significantly higher by Day 30 (p < 0.001). Additionally, the intervention group reported higher satisfaction with nursing care at discharge (p < 0.001). These findings suggest that a guideline-based nursing intervention may support more standardized nursing care and patient education during the pre- and early post-implantation care continuum. ClinicalTrials.gov, NCT07449559. Retrospectively registered on 3 March 2026. As the study was initially conducted as a practice-based evidence implementation project, trial registration was completed retrospectively before manuscript submission.
Psychiatric comorbidity is common among inpatients in general hospitals, making Mental Health Nurse Consultants (MHNCs) important providers of integrated psychological care. However, evidence regarding the practical barriers affecting MHNC role implementation remains limited, particularly in resource-constrained settings. This study aimed to explore the barriers and unmet needs experienced by MHNCs in Chinese general hospitals. A descriptive qualitative study was conducted at a tertiary general hospital in China in September 2024. Nine purposively sampled participants—including hospital administrators, physicians, nursing managers, and MHNCs—participated in a focus group interview. Data were analysed using descriptive thematic analysis with an independent multi-coder approach, with analytic rigour enhanced through investigator triangulation and reflexive team consensus. Five themes were identified: (1) structural workload and resource constraints; (2) role ambiguity and limited professional recognition; (3) clinical complexity and decision-making strain; (4) relational stress and information asymmetry; and (5) aspirations for role development. Participants highlighted that insufficient protected time, lack of dedicated consultation space, and unclear role boundaries constrained effective care delivery and interdisciplinary collaboration. Despite the recognized clinical value of MHNCs, organizational and structural barriers continue to limit role sustainability and effectiveness in general hospitals. Institutional support, including protected working time, standardized workload documentation, dedicated consultation spaces, and formal integration into multidisciplinary teams, may strengthen the implementation of MHNC services and support high-quality integrated mental health care.
Artificial intelligence (AI) is increasingly entering medicine and nursing education, raising concerns about how healthcare students respond to AI-related occupational uncertainty. AI replacement anxiety (ARA) may become more or less salient across academic days, but little is known about its short-term within-person temporal associations with state anxiety and day-level academic burnout indicators. This 10-day weekday diary study included 751 medicine and nursing students who provided 4,625 observed diary records after quality screening. Daily surveys assessed ARA and three academic burnout constructs using single day-adapted proxy indicators, together with a two-item state-anxiety measure. Two-level Bayesian dynamic structural equation modeling tested six primary dimension-specific models in the ARA-to-state-anxiety and state-anxiety-to-ARA directions. Supplementary joint multivariate models, a stricter 695-participant sensitivity sample, and a targeted calendar-spacing sensitivity analysis examined unique effects, posterior contrasts, and robustness. In the ARA-to-state-anxiety direction, higher daily ARA was associated with higher subsequent cynicism, and higher cynicism was associated with later state anxiety. This M2 component pattern remained supported when the weekend interval was represented using calendar-day spacing. In the reverse direction, higher state anxiety was consistently associated with a higher subsequent score on the academic-inefficacy proxy indicator, but the subsequent association of this indicator with ARA was less robust across model specifications and was attenuated in the weekend-spacing sensitivity analysis. The model-based indirect effects remained uncertain, with 95
Post-handover bedside observation is routine in critical care, but experience-related differences in gaze behavior during this observation remain unclear. This study compared gaze behavior according to emergency and critical care nursing experience. This cross-sectional observational study was conducted in a Japanese emergency and critical care center between September 2022 and February 2024. Sixty-six nurses were classified into four experience groups: <1 year, 1–<4 years, 4–<9 years, and ≥ 9 years. Eighteen mechanically ventilated patients contributed 66 observation sessions. Mobile eye tracking measured fixation duration, fixation count, and visit count across 13 areas of interest. Fixation duration was expressed as a percentage of observation time, while count outcomes were analyzed using negative binomial generalized estimating equations with observation duration as an offset and patient-level clustering. The Benjamini–Hochberg procedure controlled the false discovery rate across 42 tests. After false discovery rate correction, significant differences among experience groups remained for five fixation-duration, four fixation-rate, and six visit-rate measures. Pairwise differences in fixation duration and fixation rate varied in direction across areas of interest. In contrast, all significant visit-rate comparisons involving the < 1-year group showed lower rates, including for the lower limbs, insertion sites, physiological measurement devices, infusion lines and pumps, and urinary catheter. Total visit rate was also lower in the < 1-year group than in the 4–<9-year group. This categorical association remained significant after covariate adjustment and in a generalized linear mixed-model sensitivity analysis. When experience was modeled numerically with covariate adjustment, the association was attenuated (p = 0.055). Experience-related differences were observed across gaze measures, with visit rate demonstrating the most directionally consistent pattern. Nurses with < 1 year of experience showed fewer gaze entries per unit time into several patient-, device-, and treatment-related areas than nurses in a more-experienced group. The findings suggest that experience-related differences may involve not only the amount of visual attention directed to individual areas but also the frequency with which nurses direct gaze toward multiple potential sources of patient information. Gaze behavior should not be interpreted as a direct measure of clinical competence, observation quality, or clinical judgment.
Workplace incivility is increasingly recognized as a key occupational stressor in nursing. However, few studies have explored its independent association with nurse health after adjustment for established psychosocial work characteristics. This study examined the associations of workplace incivility from colleagues and supervisors with nurses’ self-rated health, burnout, and mental health status after adjusting for job control, psychological job demands, and workplace justice. This cross-sectional study was conducted between October and December 2022 at a medical center in northern Taiwan. Full-time registered nurses completed a self-administered questionnaire. A total of 900 valid responses were analyzed (response rate, 84.0
The Objective Structured Clinical Examination (OSCE) is a performance-based assessment method widely utilized in health professions education to evaluate clinical competence. However, understanding how practicing nurses experience this structured evaluation in clinical settings is essential for improving its implementation and educational value. This study aimed to explore nurses’ lived experiences of the OSCE exam. A qualitative content analysis design was conducted at Imam Reza Hospital in Kermanshah, Iran. Fourteen registered nurses were selected using purposeful sampling with maximum variation to capture diverse clinical perspectives. Data were collected through semi-structured face-to-face interviews. The interviews were transcribed verbatim and analyzed inductively using conventional qualitative content analysis. MAXQDA software was used for data organization and management. Analysis of the data revealed eight main themes: (1) meaning of the OSCE, (2) personal experience with the OSCE, (3) impact of the OSCE on professional performance, (4) challenges of OSCE implementation, (5) the OSCE in the teaching-learning process, (6) advantages and disadvantages of the OSCE, (7) expectations from the OSCE, and (8) suggestions for improvement. While participants recognized the OSCE as a highly comprehensive and educational tool that links theory to clinical practice, they also highlighted significant operational challenges, including physical fatigue, long waiting times, and stress related to station scheduling. Nurses perceive the OSCE as a valuable educational approach for reviewing clinical knowledge and verifying competencies. However, its effectiveness is heavily influenced by scheduling, organization, and station design. Aligning stations with ward-specific clinical demands and managing participant fatigue are critical to maximizing the educational and assessment utility of the OSCE. Not applicable.
Cardiopulmonary resuscitation (CPR) is a critical emergency intervention, yet evidence on CPR competence and readiness among nurses and midwives in Ghana is limited. This study assessed CPR knowledge, observed skills, self-reported readiness, and factors associated with readiness in a tertiary hospital. An analytical cross-sectional study was conducted among nurses and midwives in critical and emergency care units. Of 331 eligible staff, 271 participated (81.9
