AIM:To explore how men's entry into nursing is reshaping perceptions of the profession's identity in Türkiye, and to examine critically whether this shift de-genders the profession or subtly re-masculinises it. BACKGROUND:Research on gendered occupations has focused predominantly on women entering male-dominated fields, while the renegotiation of nursing's identity following men's entry remains underexplored. Studies in Türkiye have also relied largely on nurses' own accounts. Because professional identity is constructed relationally, understanding this transformation requires the simultaneous perspectives of multiple healthcare actors. METHODS:An exploratory qualitative design reported in line with COREQ was employed. Semi-structured interviews were conducted in one province of Türkiye with 40 purposively sampled participants: nurses (5 male and 5 female), physicians (5 male and 5 female), and patients and their relatives (10 male and 10 female). Data were analysed using Braun and Clarke's six-phase hybrid (deductive-inductive) thematic analysis with MAXQDA 2020. RESULTS:Four themes were generated: professional and personal competence; acceptance of professional identity; integration into the profession; and customising/transforming professional identity. Participants defined nursing identity through their own situational needs, with patients emphasising communication and a 'light hand' (administering injections painlessly), and physicians prioritising technical proficiency. Male nurses were positioned through physical strength, calmness and protection, and were excluded from obstetric, gynaecological and neonatal settings on privacy grounds, whereas female nurses were framed through maternal and emotional attributes. Participants also reported ambiguity in addressing male nurses, alongside a paradox whereby nurses described their occupation as low-status while patients regarded it as 'sacred'. CONCLUSION:Within this study context, men's entry appears to widen nursing's feminised boundaries without neutralising gender norms; participants' narratives suggest that gender essentialism is reproduced in a 'hybrid' form. The optimistic 'genderless profession' discourse may mask a subtle re-masculinisation, since perceived status gains seem tied to masculinised attributes rather than to a revaluation of care labour. IMPLICATIONS FOR NURSING AND HEALTH POLICY:Increasing male representation alone is unlikely to achieve structural equality. Regulators, policymakers, and nursing education institutions should adopt gender-neutral professional titles and forms of address, detach competencies from essentialist gender roles in curricula and workforce planning, avoid gender-based task allocation, and develop culturally sensitive responses to patient privacy expectations.
BACKGROUND:Acute care nursing shortages reflect constraints in education, recruitment and retention. Transparent synthesis is needed to distinguish tested interventions from plausible workforce strategies. AIM:To synthesise 2016-2026 evidence on building, recruiting and retaining the hospital nursing workforce and interpret it for nursing and health policy. METHODS:MEDLINE/PubMed, CINAHL, Embase, Scopus and Web of Science were searched on 21 February 2026. Both authors independently screened records and assessed full texts. FMI charted characteristics, and GS verified entries against reports. The prespecified build-recruit-retain structure was combined with inductive thematic development. The 24 sources comprised 11 reviews (seven systematic, two scoping, one umbrella and one integrative), five primary studies/evaluations, seven policy/standards documents and one commentary. Direct intervention evidence was separated from contextual and policy evidence; no formal risk-of-bias assessment was undertaken. FINDINGS:Transition-to-practice and nurse-residency programmes had the most consistent direct support for early-career retention, although heterogeneity limited certainty. Work-environment, staffing, leadership and safety evidence was usually observational or based on proximal outcomes. Recruitment redesign, return-to-practice and digital models had limited or emerging evidence on observed workforce outcomes. Studies were concentrated in the United States and Europe. DISCUSSION:Well-specified transition programmes merit priority; other linked strategies require evaluation with common attrition, turnover and retention definitions and claims calibrated to evidence strength. CONCLUSION:The author-developed pipeline is useful for organising evidence, but several pathways remain unvalidated and require prospective evaluation in more diverse health systems. IMPLICATIONS FOR NURSING AND HEALTH POLICY:Nurse leaders can prioritise structured transition support and test whether staffing, governance, leadership and safety reforms improve observed retention. Policymakers should consider education capacity, ethical recruitment and standardised metrics while distinguishing intervention-supported actions from policy-based or framework-generated proposals.
AIM:To design the structure and content of a cognitive restructuring intervention for people with depressive symptoms. BACKGROUND:Given the limited number of psychotherapeutic interventions currently available to mental health nurses, there is a pressing need to develop new evidence-based approaches. METHODS:A focus group methodology was used, informed by the findings of a previous scoping review. Data were collected from 11 experts during two focus group sessions and analyzed using content analysis. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was followed. RESULTS:Guidelines have been defined for theoretical conceptualization, inclusion and exclusion criteria, therapeutic objectives, diagnostic assessment tools, clinical practice context, number and duration of sessions, type of the intervention, and session content. The contents were defined and grouped into seven sessions and a prior evaluation session: (1) welcome; (2) exploration; (3) identification; (4) understanding; (5) change; (6) consolidation; and (7) follow-up session. DISCUSSION:The design of the intervention will allow it to be applied in a structured and uniform way, enabling the evaluation of its efficacy and contributing to the advancement of research in the field of mental health nursing. CONCLUSION:The focus group made it possible to design a structured cognitive restructuring intervention that could be applied by mental health nurses. IMPLICATIONS FOR NURSING:The developed intervention provides a structured framework that may support future nurse-led psychotherapeutic care and inform the evolution of mental health nursing practice and education, pending validation through feasibility and effectiveness studies. IMPLICATIONS FOR HEALTH POLICY:If validated in future studies, the intervention may inform guidelines and policies supporting nurse-led psychotherapeutic care.
AIM:Intensive care unit (ICU) nurses operate in highly demanding environments. Secure base leadership (SBL) has been proposed as a resource to help manage these demands. This study examines the associations between ICU nurses' perceptions of their supervisor as a secure base leader and their burnout and work engagement (WE), as well as the pattern of indirect statistical associations involving organizational dehumanization (OD) and psychological safety (PS) between SBL and these outcomes. DESIGN:A cross-sectional study conducted in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. METHODS:A total of 305 ICU nurses from Spain completed an online questionnaire comprising established measures assessing SBL, OD, PS, burnout, WE, and sociodemographic variables. Data were analyzed using partial least squares structural equation modeling (PLS-SEM). RESULTS:The direct associations between SBL and burnout and WE were not statistically significant. SBL was significantly associated with lower OD and higher PS, and OD and PS were significantly associated with lower burnout and higher WE. The final model explained 20% of the variance in burnout and 15% of the variance in WE. CONCLUSION:SBL was associated with ICU nurses' burnout and WE in a pattern consistent with indirect statistical associations involving OD and PS, whereas the direct associations between SBL and burnout and WE were not statistically significant. Given the cross-sectional design, these findings should not be interpreted as evidence of causal or temporal mediation. IMPLICATIONS FOR NURSING:In highly demanding clinical settings, SBL may represent a relevant leadership resource in relation to more humanized and psychologically safe work environments. IMPLICATIONS FOR NURSING POLICY:Nursing leadership development strategies may benefit from prioritizing PS and addressing OD. Such approaches are consistent with the factors associated with nurses' well-being and engagement in high-pressure healthcare settings.
AIMS:This study aimed to investigate the association between sleepiness and nurses' self-reported cognitive control, cognitive flexibility, and self-reported shift handover effectiveness during night shifts. BACKGROUND:Nurses are exposed to sleep deprivation during night shifts, constituting a substantial risk to both patient safety and workplace safety. METHOD:This descriptive study was conducted between January and June 2025 at a tertiary university hospital in Türkiye. The sample comprised 270 nurses employed in emergency departments, intensive care units, and medical/surgical wards. Data were collected using a Descriptive Information Form, the Visual Analog Scale, the Handover Evaluation Scale, and the Cognitive Control and Cognitive Flexibility Scale. EQUATOR CHECKLIST:This study was reported in accordance with the STROBE checklist. RESULTS:The nurses' mean sleepiness score was 6.41 ± 1.81. The mean sleepiness scores at midnight, 03:00 a.m., and 06:00 a.m. were 4.40 ± 2.62, 7.26 ± 2.17, and 7.58 ± 2.35, respectively. According to the analyses, higher sleepiness was associated with lower self-reported cognitive control and cognitive flexibility (β = -0.510, r = -0.379, p < 0.001) and lower self-reported shift handover effectiveness (β = -0.670, r = -0.619, p < 0.001). Additionally, a statistically significant indirect association between sleepiness and self-reported shift handover effectiveness through self-reported cognitive control and cognitive flexibility was observed (standardized β = -0.107, 95% BC CI: -0.257 to -0.023). The goodness-of-fit indices of the structural equation model indicated an acceptable model fit (CMIN/DF = 1.525, RMSEA = 0.044, CFI = 0.989). CONCLUSION:Higher night-shift sleepiness was associated with lower self-reported cognitive control and cognitive flexibility, as well as lower self-reported shift handover effectiveness. The findings highlight the importance of recognizing sleepiness as an occupational health concern and support further investigation into organizational strategies to reduce sleepiness and support nurses' cognitive functioning during night shifts. IMPLICATIONS FOR NURSING AND NURSING POLICY:Sleepiness among night-shift nurses should be recognized as an important occupational health and workforce concern. Healthcare organizations may consider monitoring sleepiness and exploring strategies to support nurses' cognitive functioning during night shifts. However, further multisite longitudinal and intervention studies are needed to determine the effectiveness of specific scheduling and fatigue-management interventions.
AIM:To describe nursing professional values among nursing interns in China and examine the association between self-leadership and these values. BACKGROUND:Nursing interns are an essential part of the future nursing workforce, and the development of professional values during internships supports ethical practice and high-quality patient care. Self-leadership, a self-regulatory process that guides motivation and behaviour, has been increasingly recognised as a resource for professional development. However, evidence on its relationship with nursing interns' professional values remains limited. METHODS:We conducted a cross-sectional survey at a tertiary general teaching hospital in China. Participants completed a general information questionnaire, the Chinese versions of the Revised Self-Leadership Questionnaire (RSLQ) and the Nurses Professional Values Scale-Revised (NPVS-R). Associations were examined using Pearson's correlation and multiple linear regression analyses. RESULTS:The mean total NPVS-R score among the 374 nursing interns was 96.36 ± 16.38. Pearson's correlation analysis showed a significant positive correlation between self-leadership and nursing professional values among nursing interns (r = 0.435, p < 0.001). Multiple linear regression analysis showed that gender (B = 0.254, p = 0.002), participation in nursing-related academic activities (B = -0.148, p = 0.021), and self-leadership (B = 0.427, p < 0.001) were significantly associated with nursing interns' professional values. The model accounted for 23.2% of the variance (adjusted R2 = 0.232). CONCLUSION:The findings suggest that nursing interns with stronger self-leadership may be more inclined to reflect on professional expectations and align their behaviour with professional values during clinical placement. Activism-related professional values received comparatively lower ratings. Self-leadership was positively associated with nursing interns' professional values and may warrant further investigation in internship education and support. IMPLICATIONS FOR NURSING:Practice-based self-leadership activities, preceptor coaching, and mentored professional socialisation could be explored in future research on nursing internship education. IMPLICATIONS FOR HEALTH POLICY:At the organisational and policy levels, the findings may inform future evaluation of approaches involving internship standards, structured mentorship, and clinical learning environments.
AIM:We investigated factors associated with online health misinformation in nurses. In particular, we examined the association between several demographic variables, nurses' perceived integrity of scientists, and online health misinformation susceptibility. BACKGROUND:The ability to identify and counteract misinformation in healthcare is more critical than ever to safeguard public health and maintain confidence in evidence-based practices. METHODS:For this cross sectional study, we collected our data in Greece through an online survey during October 2025. We used the Health-Related Online Misinformation Susceptibility Scale to measure online health misinformation behavioral susceptibility in our nurses. We used the Trust in Scientists Scale to measure levels of nurses' perceived integrity of scientists. Our study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. RESULTS:We found that nurses' perceived integrity of scientists is associated with online health misinformation behavioral susceptibility. Moreover, we found that nurses with an MSc/PhD diploma had lower levels of misinformation susceptibility. Additionally, interest in politics was associated with lower misinformation susceptibility. CONCLUSION:Our findings showed a negative association between nurses' perceived integrity of scientists and online health misinformation susceptibility. Additionally, educational level and interest in politics were associated with online health misinformation susceptibility. IMPLICATIONS FOR NURSING:Identification of factors associated with nurses' misinformation susceptibility is crucial to identify high-risk groups and develop appropriate strategies to reduce this phenomenon. In this context, policymakers and healthcare organizations should reduce nurses' misinformation susceptibility and improve their ability to detect fake news. IMPLICATIONS FOR HEALTH POLICY:Well-informed nurses are essential for providing the public with accurate and reliable information. In this way, public health can be promoted, and individuals' quality of life can be improved.
AIM:To conduct a document-based competency alignment analysis of seven selected, publicly available South Korean medical interpreter certification and training documents against established international competency standards, and to propose a conceptual Interpreter-Nurse Pathway informed by this analysis. BACKGROUND:Language barriers mediated by untrained personnel pose substantial threats to patient safety and health equity among linguistic minorities. The documentary articulation of internationally recognized competencies within selected South Korean certification and training materials therefore warrants systematic examination. METHODS:A qualitative document analysis was performed on seven selected, publicly accessible documents comprising certification protocols, evaluative criteria, and educational syllabi. Using a benchmark of eight international competency domains, the documents were organized through an author-developed 0-2 descriptive mapping framework that distinguishes three levels of documented integration: absence, mention without explicit instructional or assessment linkage, and explicit linkage to both instruction and assessment. RESULTS:Within the seven documents analyzed, findings indicate a marked gap between stated competency objectives and their documented linkage to instruction and assessment. Although foundational elements such as ethics demonstrated strength, advanced technical skills-specifically remote interpreting and strategic note-taking-lacked substantive inclusion. Only three of the eight benchmark domains (37.5%) were explicitly linked to both instruction and assessment within the selected documents (Level 2); the other five were either mentioned without such linkage (Level 1) or absent (Level 0). DISCUSSION:The gaps identified in how the selected documents link instruction and assessment provide a basis for considering future curriculum and policy development. CONCLUSION:Within the documents analyzed, only three of the eight benchmark competency domains appeared in both curricular instruction and formal assessment. Of the remaining five, three were mentioned without being included in both, and two were absent. To address these gaps, this study outlines a conceptual Interpreter-Nurse Pathway as a policy and workforce-development proposal informed by the documentary analysis. IMPLICATIONS FOR NURSING AND HEALTH CARE POLICY:Specialized interpreting training in nursing curricula may offer an additional form of professional specialization for nurses with relevant linguistic proficiency. This study proposes that policymakers consider formal interpreter-nurse pathways supported by university-hospital collaboration. The feasibility, implementation requirements, and outcomes of this proposal were not evaluated; if pursued, it would require defined professional boundaries, advanced training modules, and appropriate incentive structures for nurses with specialized linguistic proficiency.
AIM:To synthesise and critically appraise empirical evidence on midwives' climate change awareness and planetary health literacy, the psychological attributes underpinning their readiness for climate-related maternal and newborn risks, the educational interventions targeting these attributes, and the systemic factors shaping their preparedness. BACKGROUND:Climate change threatens maternal and newborn health through extreme heat, flooding, and disruption of services. Midwives are well positioned to deliver climate-responsive care, yet the constructs used to describe their preparedness-awareness, literacy, resilience, and readiness-are inconsistently defined and measured, and no prior systematic review has synthesised and appraised this evidence with explicit attention to what individual studies actually assessed. METHODS:A systematic review was conducted according to PRISMA 2020 and registered with PROSPERO (CRD420251135183). Six databases (PubMed/MEDLINE, Embase, Web of Science, Scopus, PsycINFO, and CINAHL) were searched for primary empirical studies published between January 2000 and July 2025 involving practising midwives, student midwives, or midwifery academics. The Capability-Opportunity-Motivation-Behaviour (COM-B) model guided the synthesis. Constructs and instruments were extracted exactly as reported and mapped transparently to review domains. Risk of bias was assessed with RoB 2 and Joanna Briggs Institute tools. RESULTS:Six studies met the eligibility criteria: two randomised controlled trials, three qualitative studies, and one consensus study, together involving 333 midwives, student midwives, and midwifery academics in Türkiye, Australia, and the Democratic Republic of the Congo. No study directly measured planetary health literacy with a validated instrument, and none measured psychological readiness as a defined construct; the available evidence comprised proxy indicators, principally climate change awareness, resilience, and perceived stress. Interactive climate change education significantly improved midwifery students' awareness, and resilience-based training improved practising midwives' resilience and reduced stress. Qualitative evidence indicated that midwives recognise climate-related threats to mothers and newborns but respond through improvised strategies in the absence of formal training, protocols, and institutional support. Both trials were rated at low risk of bias; the four non-randomised studies carried some concerns. CONCLUSION:Direct evidence on midwives' planetary health literacy and psychological readiness does not yet exist. A small, geographically concentrated body of evidence on related proxy constructs suggests that educational and resilience-focused interventions are promising, while systemic supports remain largely absent. Construct-explicit measurement, validated instruments, and system-level preparedness research are priorities. IMPLICATIONS FOR NURSING:Educators and professional-development providers can draw on validated curricular competency content and two trial-tested pedagogies-interactive climate change education and resilience-based training-while recognising that transfer to clinical practice remains untested. IMPLICATIONS FOR NURSING POLICY:Policy should prioritise the development and validation of measurement instruments for planetary health literacy and psychological readiness in midwifery, the integration of climate-related competencies into curricula and accreditation, and investment in the institutional protocols and supports whose absence this review consistently identified.
AIM:To present a descriptive, practice-based account of a nurse practitioner-led mobile health clinic serving individuals experiencing homelessness, guided by the PRIME-NP framework. BACKGROUND:Homelessness is associated with health inequities and limited access to care. Individuals face barriers including transportation, stigma, and displacement. Although mobile outreach may help address these barriers, little work has examined competencies for nurse practitioners in unstable, resource-limited environments. In this clinic, nurse practitioners provide field-based care, including wound management, chronic disease assessment, infectious disease testing, and care coordination in street and encampment settings. SOURCES OF EVIDENCE:This paper presents a descriptive, practice-based account of a quality improvement initiative conducted within a mobile clinic that provides outreach services to individuals experiencing homelessness in community settings. It draws on operational summaries, interdisciplinary workflows, and field-based care delivery. Interpretation of Nurse Practitioners' roles was guided by the PRIME-NP framework, which conceptualizes competencies across five domains. DISCUSSION:Nurse practitioners enacted PRIME framework roles, including relationship-building, assessment, care coordination, and education. They delivered primary and wound care and infectious disease testing while addressing challenges such as displacement, medication loss, behavioral health concerns, and limited communication access. Collaboration with pharmacy, legal, and social services partners supported care coordination and continuity during outreach activities. CONCLUSION:Mobile services led by nurse practitioners may provide accessible, low-barrier care for individuals who cannot access traditional health systems and may contribute to opportunities for trust-building, engagement, and continuity of care. IMPLICATIONS FOR NURSING:These insights underscore the need to integrate mobile outreach competencies into nurse practitioner education. IMPLICATIONS FOR HEALTH POLICY:Sustainable funding and supportive regulation are needed to integrate nurse practitioner-led mobile services into community health systems.
AIM:This study explores the challenges experienced by Malaysian nurses working in Singapore, Saudi Arabia, and Brunei. INTRODUCTION:Global nurse migration has intensified in response to workforce shortages and transnational healthcare demands. Although the experiences of internationally educated nurses have been widely examined, limited research has focused on the context-specific challenges encountered by Malaysian nurses across different host-country environments. METHODS:A qualitative design was employed. In-depth virtual interviews were conducted with 12 Malaysian nurses recruited through purposive and snowball sampling. Interviews were transcribed verbatim and analyzed using thematic analysis with the support of NVivo software. The study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines to ensure methodological rigor and transparency. RESULTS:Three themes were identified: (1) professional and practice challenges, (2) social and cultural challenges, and (3) psychological and interpersonal challenges. Participants reported experiences of restrictive credentialing systems, intensified workload expectations, technological and systematic adaptation pressures, dietary and cultural adjustment, and psychological stress. The nature and intensity of these challenges varied across host countries, reflecting differences in regulatory frameworks, institutional cultures, and sociocultural environments. DISCUSSION:The findings demonstrate that migrant nurses' experiences are shaped not only by individual adjustment processes but also by structurally mediated and context-dependent factors within transnational healthcare systems. CONCLUSIONS:This study highlights the importance of host-country-sensitive and stakeholder-specific strategies to promote equitable professional integration, psychological well-being, and long-term workforce sustainability. IMPLICATION FOR NURSING:Nursing leaders and healthcare institutions should implement culturally responsive orientation, structured mentorship, and supportive workplace environments to facilitate the professional integration and well-being of migrant nurses. IMPLICATION FOR NURSING POLICY:Coordinated transnational policies are needed to address institutional, regulatory, and professional barriers affecting migrant nurse integration.
AIM:To map the available evidence on the assessment of migrant nurse and midwife workplace integration in global healthcare settings. BACKGROUND:Globally, migrant nurses and midwives are important resources in mitigating workforce shortages. Existing evidence focuses on the orientation stages of migrant nurse and midwife transition into the healthcare setting rather than their long-term workplace integration. DESIGN/METHODS:The nine databases searched were CINAHL, Medline, Web of Science, Embase, PsycINFO, ASSIA, SicELO, Maternity & Infant Care and Global Index Medicus. An initial search was performed in December 2021 and updated in December 2025. RESULTS:A total of 91 articles were included, comprising qualitative (n = 48), quantitative (n = 13), mixed-methods (n = 6), others (n = 23) and one book chapter. Multiple definitions of workplace integration were found, and 23 tools were identified. CONCLUSIONS:Workplace integration, a multidimensional, time-dependent process, requires collaboration among stakeholders. A standard definition will help to clarify their responsibilities. Key factors ensuring successful integration include promoting effective communication, supporting knowledge advancement, facilitating career development and skill utilisation. The development of standardised interventions with flexibility for local adaptation will support successful workplace integration. IMPLICATIONS FOR NURSING/HEALTH POLICY:Findings highlight the need for policy developers to support migrant nurses and midwives with interventions focused on linguistic challenges, cultural competence and differing care models, that are key to successful integration. Future research must include host stakeholders' perspectives to fully understand the dynamics of workplace integration.
AIM:This review aimed to map the available evidence on nurses' engagement in healthcare policy-making and to identify the foundational concepts that shape this engagement. BACKGROUND:Nurses represent the largest professional group in healthcare systems and hold a central position in responding to population health needs. However, they remain underrepresented in policy-making arenas. Their engagement is increasingly recognised as essential for building equitable, responsive and patient-centred healthcare systems, yet it is limited by insufficient policy education, restricted access to decision-making spaces, and the absence of a guiding conceptual framework. METHODS:This scoping review was conducted using established methodological guidance for evidence mapping. A Pragmatic utility approach informed the conceptual analysis, allowing the available literature to be examined in relation to the usefulness, clarity, and applicability of concepts describing nurses' policy engagement. SOURCES OF EVIDENCE:A systematic search of peer-reviewed databases was complemented by manual searches of reference lists. Eligible sources examined nurses' engagement, participation or influence in healthcare policy-making across clinical, organisational, professional, or governmental contexts. DISCUSSION AND CONCLUSION:Nurses' engagement in policy-making was described through interrelated antecedents, attributes, and outcomes. Individual factors and professionalism were important antecedents, but engagement was strongly shaped by contextual conditions, including organisational support, opportunities for collaboration, and access to policy spaces. The findings suggest that policy participation is relational and depends on the ability to translate nursing expertise into policy-relevant messages. Engagement was associated with enhanced advocacy, exposure to positive role models, and education and information seeking, which may reinforce further participation. IMPLICATIONS FOR NURSING PRACTICE:Nursing organisations, educators, and leaders should strengthen policy and advocacy education, mentorship, leadership development, and opportunities for nurses to participate in policy-related activities. IMPLICATIONS FOR HEALTH POLICY:Health systems should create organisational mechanisms that provide protected time, formal recognition, and access to policy forums, enabling nurses to contribute more effectively to policy decisions.
Aim To adapt and validate the Multidimensional Inventory of Perfectionism for hospital nurses, identify distinct perfectionism profiles, and examine associated factors and outcomes.Background Perfectionism in nursing, shaped by both internal standards and diverse external pressures, requires a multidimensional, context-sensitive assessment to identify nurses at risk for poor health and lower perceptions of patient safety.Methods This descriptive cross-sectional study used expert review to assess content validity and a survey of hospital nurses to test construct validity and reliability. Latent profile analysis identified subgroups, and regression models examined associations with personal and work factors, emotional distress, and self-perceived patient safety.Results The adapted scale showed strong validity and high internal consistency. Four latent profiles emerged: Nonperfectionism, Self-Oriented Perfectionism, Externally Pressured Nonperfectionism, and High-Pressure Perfectionism. Profile membership was related to gender, nursing experience, staffing adequacy, and pandemic-related patient care. Compared with Nonperfectionism, all three profiles involving perfectionistic tendencies or external pressure were associated with greater emotional distress. Externally Pressured Nonperfectionism and High-Pressure Perfectionism were also associated with less favorable self-perceived patient safety, with High-Pressure Perfectionism showing a particularly adverse pattern.Discussion The adapted measure effectively captured internal dimensions and source-specific external pressures of nurse perfectionism. Profiles differed meaningfully in risks for emotional well-being and safety perceptions.Conclusion The study findings support healthcare organizations, nurse leaders, and policymakers in developing targeted interventions to safeguard nurses' well-being and optimize patient care.Implications for Nursing Nurse leaders should address high-pressure perfectionism through unit-level staffing review, supportive feedback, and just culture-based error review.Implications for Health Policy Health policy should support minimum nurse-to-patient ratios and non-punitive incident reporting systems to reduce harmful perfectionistic pressures and support sustainable nursing practice.
BACKGROUND:Genomics is reshaping healthcare and is increasingly recognized as essential to nursing. Although international organizations call for aligned genomic competencies, integration in undergraduate education remains limited. Curriculum-mapping studies show what is taught, but little is known about how educators interpret genomic relevance or navigate institutional constraints. AIM:To explore how nursing educators in Portuguese higher education institutions understand, value, and operationalize genomics within nursing education programs. METHODOLOGY:A qualitative, exploratory study grounded in interpretivist and reflexive epistemology was conducted through online focus groups with ten nursing educators. Data were generated through dialogic discussions and analyzed using reflexive thematic analysis. RESULTS:Three themes captured shared meanings. Educators viewed genomics as aligned with holistic and person-centered nursing. However, its curricular presence was described as fragmented, implicit, and predominantly taught through biomedical lenses. Structural constraints, such as curriculum saturation, regulatory rigidity, uneven faculty expertise, and reduced contact hours, were perceived as barriers to systematic integration. Participants also constructed feasible pathways to achieve integration, including transversal embedding, case-based pedagogies, flexible initiatives, and interprofessional collaboration. DISCUSSION:Educators' interpretations illustrate how global recommendations are adapted within local realities. They also highlight pragmatic strategies that can support incremental and context-sensitive integration of genomics into nursing education. CONCLUSION:Purposeful integration requires coordinated action across pedagogical design, faculty development, and system-level structures. IMPLICATIONS FOR NURSING:Strengthening faculty preparation and embedding genomic concepts across curricula can enhance genomic literacy. IMPLICATIONS FOR HEALTH POLICY:Aligning educational standards and regulatory frameworks with genomic competencies is key to preparing a genomics-ready nursing workforce.
Aim This study aimed to examine the relationship between nurses' perceptions of the green organizational climate, perceptions of green team climate, and awareness of consequences, are related to their green behavior in hospitals.Background Healthcare is a resource-intensive sector where everyday employee green behavior can meaningfully reduce environmental impacts. Nurses, who work at points of concentrated resource use and waste generation, are pivotal for sustainability in hospitals. Yet, factors associated with nurses' green behavior remain underexplored.Methods This study adopted a correlational, cross-sectional design and is reported in accordance with the STROBE guidelines. Data were collected from 649 nurses working in six hospitals in South Korea through an online survey conducted in January and February 2025. Multiple linear regression estimated associations between the three predictors and green behavior, controlling for age, conscientiousness, and direct care provision of nurses.Results Green team climate emerged as the strongest predictor of nurses' green behavior, followed by awareness of consequences and green organizational climate.Discussion Team-level environmental norms may have a stronger influence on nurses' green behavior than broader organizational climate. Awareness of environmental consequences also contributes to green behavior.Conclusions Nurses' green behavior was positively associated with both contextual climates and individual cognitions.Implications for Nursing Promoting pro-environmental team norms, enhancing consequence awareness, and aligning organizational practices with sustainability priorities may encourage green behavior. Peer-led environmental initiatives at the unit-level and consequence-awareness training can strengthen shared norms among the team and promote green behavior.Implication for Health Policy Hospitals should embed environmental sustainability in policies, performance management, and operating procedures, including procurement and waste management. At the larger systems level, environmental metrics could be tied to accreditation and funding.
AIM:To identify latent organizational-psychosocial profiles among clinical nurses based on their perceptions of workplace social capital (WSC), professional identity (PI), and work-related quality of life (WRQoL), and to explore demographic and occupational predictors of profile membership. BACKGROUND:WSC, PI, and WRQoL are critical factors influencing nurses' occupational well-being, job satisfaction, and retention. With increasing managerial focus on these elements, the potential for these factors to form distinct latent profiles remains to be explored. METHODS:A cross-sectional survey was conducted among 1,630 nurses from three hospitals in China. Latent profile analysis identified subgroups based on 14 dimensions across the WSC, PI, and WRQoL scales. Multinomial logistic regression was used to examine factors associated with subgroup membership. RESULTS:Three latent profiles were identified: Resource-Deprived and High-Stress Group, Adaptive-Stable Group, and High Resource-High Identity Group. Multinomial logistic regression showed that lower hierarchical (N2), lower monthly income (≤5000 RMB), specific department assignments (outpatient and medical technology), and strong turnover intentions were significantly associated with membership in the Resource-Deprived and High-Stress Group. Nurses in this group were also more likely to experience higher stress and resource deprivation compared with those in the other profiles. CONCLUSION:Nurses display significant organizational-psychosocial heterogeneity, influenced by structural factors such as hierarchical position, clinical specialty, income level, and turnover intention. IMPLICATIONS FOR NURSING:Nurse managers should recognize the heterogeneity within nursing groups and, for those in resource-deprived and high-stress profiles, optimize shift schedules, reduce workloads, and provide psychological support to alleviate physical and emotional stress. IMPLICATIONS FOR NURSING POLICY:Policymakers should design tailored professional development initiatives for different nurse subgroups, ensure equitable and competitive remuneration systems, and enhance nurse well-being and retention.
AIM:To explore the experiences, perceptions, motivations, and empowerment experiences of nurses working in refugee camps. BACKGROUND/INTRODUCTION:Refugee camps are frequently marked by resource scarcity, instability, and cultural diversity, shaping how health care is delivered. Nurses are essential in providing care in these settings, yet their experiences remain understudied. METHODS:A systematic review and meta-synthesis were conducted using Sandelowski and Barroso's approach. The protocol was registered in PROSPERO (CRD42024541434). Searches were conducted in April 2025 across PubMed, CINAHL, Scopus, LILACS, CuidenPlus, and PsycINFO. RESULTS:Sixteen articles were included. Eight themes and 28 subthemes emerged, grouped into two meta-themes: (1) Motivations and empowerment experiences; and (2) Challenges faced by nurses. Motivations included prior experiences in international cooperation, inspiration from others, satisfaction from contributing, personal values, and professional and personal development. Challenges were linked to the refugee population, the context, and healthcare delivery. DISCUSSION:Findings highlight the importance of addressing systemic and cultural barriers in refugee healthcare. Cross-cultural training, psychological support, and adequate resources are critical to sustaining nurses' well-being and care quality in these challenging settings. CONCLUSION:Nurses working in refugee camps navigate a complex balance between strong professional motivation and substantial workplace challenges. Strengthening support systems and improving working conditions are crucial for promoting both nursing well-being and high-quality care in humanitarian contexts. IMPLICATIONS FOR NURSING:Nursing education and professional development should integrate cultural competence, communication skills for multilingual settings, and strategies for managing emotional strain in humanitarian environments. IMPLICATIONS FOR NURSING AND HEALTH POLICY:Health policies should prioritize integrated support frameworks that strengthen health systems in refugee contexts, ensure adequate staffing and resources, and provide sustained psychological and organizational support for nurses delivering care in humanitarian settings.
AIM:To examine how nurses experience and navigate the emotional and interpersonal demands of working with informal caregivers in acute care settings and to identify opportunities for institutional and policy-level support. BACKGROUND/INTRODUCTION:Informal caregivers play an essential role in patient and family-centered care, yet their involvement often creates emotional and relational strain for nurses. Nurses frequently become the primary outlet for caregiver distress while receiving little preparation or organizational support. Limited research has explored these dynamics from the nurse's point of view. METHODS:A qualitative descriptive design was used, guided by relational cultural, emotional labor, and organizational role theories. Semi-structured interviews were conducted with registered nurses working in diverse acute care environments. Data were analyzed using reflexive thematic analysis to identify patterns in how nurses interpret and manage caregiver interactions. FINDINGS:Nurses encountered two primary challenges. First, caregiver distress often escalated into hostility or intense emotional expression, creating significant emotional strain and moral tension alongside clinical responsibilities. Second, nurses described persistent ambiguity around caregiver roles, driven by limited training, inconsistent workflows, and the absence of institutional guidance. Nurses used individualized communication strategies, improvised boundaries, and interdisciplinary collaboration to support caregivers and reduce conflict. DISCUSSION:Caregiver engagement is a hidden dimension of nursing work that places substantial emotional and relational demands on nurses. These demands reflect systemic gaps rather than isolated interpersonal problems and require structured organizational responses. CONCLUSION:Supporting nurses in caregiver engagement requires clearer role expectations, standardized caregiver onboarding, simulation-based communication and de-escalation training, and routine opportunities for reflective debriefing. IMPLICATIONS FOR NURSING POLICY:Nursing education and hospital policy should formally integrate caregiver engagement into curricula, orientation, and unit protocols. Health policy must include guidance on caregiver roles, workplace safety, and interdisciplinary resources to strengthen family-centered care and reduce the emotional burden on nurses.
AIM:To identify nurses' preventive support needs related to the second victim phenomenon and develop consensus-based strategies. BACKGROUND:Patient safety incidents can trigger the second victim phenomenon, causing psychological distress among healthcare professionals. While early approaches focused on post-incident support, recent research emphasizes preventive strategies. Pre-incident support remains limited, underscoring the need for nursing-specific preventive strategies. METHODS:A convergent mixed-methods design combined focus group interviews and a three-round Delphi survey. Eleven nurses explored preventive support needs through thematic analysis. Fourteen experts evaluated necessity, feasibility, and validity via Delphi. Reporting followed the Consolidated Criteria for Reporting Qualitative Research and Guidance on Conducting and Reporting Delphi Studies. RESULTS:Nurses experienced emotional distress, stigma, and turnover intentions, exacerbated by limited formal support. Four key components were identified: incident prevention and response, understanding of the second victim phenomenon, post-incident support, and access to resources. Key strategies included case-based education, empathy training, and anonymous digital delivery. Experts validated these measures and advocated for systematic integration into institutional frameworks. DISCUSSION:Findings align with and extend recent international models of second victim support. Blame-prone cultures, hierarchical structures, and shift-based work shaped distress and preferences for anonymous digital support, with managerial engagement as a cross-cutting enabler. CONCLUSION:Preventive education, leadership engagement, and organizational preparedness should be embedded into routine systems to ensure accessible and sustainable support for second victims. IMPLICATIONS FOR NURSING:Preventive second victim interventions should be integrated into orientation programs, with leadership training to foster psychological safety and digital platforms to expand access for shift-based nurses. IMPLICATIONS FOR HEALTH POLICY:Prevention strategies should be embedded in national guidelines and accreditation standards, requiring standardized protocols, dedicated funding, and coordinated policy commitment.
