Background: A supportive clinical learning environment is essential in nursing education; however, evidence regarding predictors of student satisfaction in Southeast European higher education contexts remains limited. Objective: To identify demographic and item-level CLES+T predictors of nursing students’ overall satisfaction with the clinical learning environment in Kosovo. Methods: A cross-sectional study was conducted between April and May 2025 among 300 undergraduate nursing students. Data were collected using the Clinical Learning Environment, Supervision and Nurse Teacher (CLES+T) scale, while overall student satisfaction was assessed using a separate single-item measure. Data were analyzed using descriptive statistics, non-parametric tests, and multiple linear regression analyses. The primary demographic model included sex, year of study, and economic status, while a second model included all 34 CLES+T items simultaneously. Results: The demographic model was statistically significant, F(4, 295) = 35.894, p < 0.001, explaining 32.7% of the variance in satisfaction (R² = 0.327; adjusted R² = 0.318). Compared with first-year students, second- and third-year students reported significantly lower satisfaction, while sex and Economic Status were not significant predictors. The CLES+T item-level model was statistically significant, F(34, 265) = 18.319, p < 0.001, explaining 70.2% of the variance (R² = 0.702; adjusted R² = 0.663). The strongest positive predictors were positive joint meetings with the mentor and nurse teacher (β = 0.415), feeling comfortable going to the ward at the start of the shift (β = 0.335), and sufficient meaningful learning situations (β = 0.249). Because several item-level predictors showed elevated multicollinearity, individual coefficients, particularly negative coefficients, should be interpreted cautiously. Conclusion: Nursing students’ satisfaction was associated with both academic year and specific relational, supervisory, and pedagogical characteristics of the clinical learning environment. Supportive mentorship, meaningful learning opportunities, and effective integration of theory and practice remain important components of positive clinical learning experiences.
Background: Family caregivers are central to home-based care for diabetic foot ulcers (DFUs), but domain-specific knowledge gaps may shape attitudes toward holistic family support. Objective: To examine caregivers’ knowledge and attitudes across physical, psychological, social, and spiritual domains of DFU support and identified predictors of total attitude. Methods: A cross-sectional study was conducted among 274 family caregivers at a tertiary referral hospital in Batam City, Indonesia, from March to July 2024. Data were analyzed using descriptive statistics, Friedman tests, Spearman correlations, and multiple regression with robust standard errors. All statistical analyses were conducted in R version 4.5.0. Results: The mean total knowledge score was 15.42 (SD = 1.44), and the mean total attitude score was 62.13 (SD = 8.51). Knowledge was highest in the physical domain (M = 86.34%, SD = 3.17) and lowest in the psychological domain (M = 17.82%, SD = 6.67). Friedman tests showed significant differences across knowledge domains, chi-square(3) = 783.668, p < 0.001, and attitude domains, chi-square(3) = 435.191, p < 0.001. Significant correlations included total knowledge with physical attitude (rho = 0.565, p < 0.001) and spiritual knowledge with total attitude (rho = 0.564, p < 0.001). The adjusted regression model explained 38.1% of the variance in total attitude score. Spiritual knowledge (B = 0.416, 95% CI [0.312, 0.520], p < 0.001), physical knowledge (B = 0.722, 95%CI [0.393, 1.052], p < 0.001), and psychological knowledge (B = 0.180, 95% CI [0.056, 0.304], p = 0.005) were significant predictors; social knowledge was not significant. Conclusion: Caregiver attitudes toward holistic DFU support were strongly associated with domain-specific knowledge. Family-centered education could usefully address the physical, psychological, social, and spiritual needs of caregivers. Nurses could consider screening for domain-specific knowledge gaps, particularly in psychological support, and offering culturally sensitive family education to strengthen caregiver readiness for home-based DFU care.
Background: Chronic non-communicable diseases (NCDs) are increasing among the Tai Saek ethnic minority in Thailand, yet little is known about how this community culturally interprets and manages NCDs in daily life. Objective: To develop a substantive theory explaining how the Tai Saek ethnic group perceives NCDs and manages them within changing lifestyles. Methods: A grounded theory design based on Strauss and Corbin was used. Eighteen Tai Saek adults (10 with NCDs, 8 without) were theoretically sampled from two villages in Nakhon Phanom province, Thailand. Data were collected from August 2024 to April 2025 through in‑depth interviews, field notes, and theoretical memos, and analyzed with ATLAS.ti using constant comparative analysis. Results: The core category, Cultural Perceptions and Risk Management of NCDs, describes a non-linear process where Tai Saek people balance traditional lifeways, modern influences, and spiritual beliefs. This paradigm model consists of interrelated components: (1) Contextual Conditions, characterized by a dual lifestyle involving modernized agriculture, dietary shifts, generational negotiations, and traditional “Sum Saew” gatherings; (2) Causal Conditions, where individuals construct meanings of NCDs (behavioral vs. genetic) and respond emotionally and behaviorally; (3) Action/Interaction Strategies, which selectively integrate indigenous practices (ancestor worship) with biomedical care; and (4) Consequences, which include both positive adaptation (cultural empowerment) and negative outcomes (delayed biomedical care due to reliance on rituals). Conclusion: The study demonstrates that Tai Saek people do not simply adopt biomedical advice but actively filter it through ancestral beliefs and modern constraints. Nursing care should assess cultural transitions, acknowledge spiritual rituals, and co‑design NCD management plans respecting local wisdom.
Background: Psychological distress, including stress and depressive symptoms, is common among people with diabetes and may negatively influence self-management and clinical outcomes in primary care settings. Objective: To assess and compare levels of perceived stress and depression among patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). Methods: This cross-sectional study included 297 patients with diabetes recruited using convenience sampling from eight primary care centers in Prishtina, Kosovo, between March 2025 and August 2025. Perceived stress was measured using the Perceived Stress Scale (PSS), while depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9). Demographic characteristics and selected clinical parameters, including waist circumference and systolic and diastolic blood pressure, were obtained from medical records. Categorical and continuous variables were analyzed using chi-square and Mann–Whitney U tests, with Cramér’s V measuring categorical effect size. Statistical significance was set at p < 0.05. Results: Patients with type 1 diabetes mellitus (T1DM) were significantly younger than patients with type 2 diabetes mellitus (T2DM). Exploratory item-level analysis of perceived stress did not demonstrate consistent differences between the groups; however, interpretation of stress-related findings should be approached cautiously due to the low internal consistency of the PSS in the present sample. Depressive symptom severity differed significantly between groups (p = 0.005, Cramér’s V = 0.224). Conclusion: Significant differences were observed in depressive symptom severity between patients with T1DM and T2DM, whereas interpretation of perceived stress findings remains limited. Although these findings support the importance of psychological assessment in diabetes care, they should be interpreted cautiously given the cross-sectional design and methodological limitations of the study. Healthcare professionals, including physicians and nurses, should routinely screen for depression in diabetes care and provide appropriate follow-up or referral based on symptom severity.
Background: Gestational diabetes mellitus (GDM) poses escalating global health threats, particularly in China, with significant maternal-fetal health risks. Effective self-management is crucial to mitigate adverse maternal-neonatal outcomes. Objective: The aim of this study was to describe the status of self-management behavior and its associated factors in pregnant women with diet-controlled GDM. Methods: A cross-sectional study recruited 160 pregnant women with diet-controlled GDM from the antenatal clinic of the Second Affiliated Hospital of Wenzhou Medical University from August to October 2024. Eligible participants were identified in the hospital’s antenatal registration system and selected using simple random sampling based on assigned queue numbers. Data were collected through self-administered questionnaires assessing SMB, GDM knowledge, illness perception, self-efficacy, social support, and perception of care received. Data were analyzed using SPSS 27.0 with hierarchical multiple regression analysis. Results: A moderate level of SMB was observed in 45.6% of the participants (n = 73). Scores for exercise (M = 13.60, SD = 5.60) and glucose monitoring (M = 11.86, SD = 4.32) ranked lowest among SMB domains. The final hierarchical multiple regression model explained 60.6% of the variance in SMB among pregnant women with GDM (R² = 0.606, F(6,153) = 39.28, p < 0.001). Significant factors associated with SMB included GDM knowledge (β = 0.296, 95% CI: 0.869 to 2.161, p < 0.001), social support (β = 0.252, 95% CI: 0.455 to 1.358, p < 0.001), illness perception (β = 0.188, 95% CI: 0.137 to 0.635, p = 0.003), self-efficacy (β = 0.183, 95% CI: 0.086 to 0.499, p = 0.006), and pregnancy-related anxiety (β = -0.188, 95% CI: -1.187 to -0.286, p = 0.002). Perception of care received was not significantly associated with SMB (β = 0.033, 95% CI: -0.303 to 0.579, p = 0.537). Conclusion: These findings identify potential correlates for further nursing interventions, suggesting that tailored, culturally sensitive education, family-centered support, and multidisciplinary care may be beneficial in supporting SMB. Such efforts should prioritize reducing anxiety while fostering knowledge, self-efficacy, and social support.
