In Creative Nursing Volume 32, we introduced a new series on Critical Approaches for Nursing Research. The primary purpose of this series is to help nurse researchers understand, design, and conduct research that is necessary for dismantling structural inequalities in healthcare. Critical research is pertinent to unraveling the sociohistorical context and nature of knowledge, and how generated knowledge can bring about disruptive change in society. This final editorial in the series offers an overview of queer research methods.
Inpatient psychiatric nurses practice in environments where therapeutic care, safety monitoring, patient agency, behavioral containment, and institutional order are deeply intertwined. Although psychiatric nursing is often described through clinical tasks, risk management, or therapeutic relationships, less attention has been given to its sociological complexity as socially organized boundary work. This discussion article uses a sociology-of-nursing lens to examine how inpatient psychiatric nurses practice at the boundary of care and control. Nurses are expected to build trust, preserve dignity, monitor risk, maintain the milieu, redirect behavior, set limits, support patient agency, document clinical concerns, and coordinate with broader institutional demands. These responsibilities are not simply technical tasks; they are forms of relational, ethical, and organizational labor that shape professional identity under constraint. Making this labor visible can clarify how psychiatric nurses preserve care and compassion within regulated, risk-oriented settings. The paper concludes with implications for nursing practice, education, leadership, policy, and research.
BackgroundClinical spaces impact patient-provider interactions, health-care professionals' teamwork, and overall patient health-care outcomes. There is a strong connection between the physical environment, health-care organizational culture, patient care outcomes, and nurses' job satisfaction. The nurse station is a significant traditional spatial hub of activity in hospitals where nurses gather to work, socialize, collaborate, and coordinate care. Yet, less is known about the influence of nurse station design and institutional texts and ruling relations on care delivery and clinical interactions in Ghana.AimThis paper explores the role of nurse station design and institutional texts (the documentary materials such as print, photographs, media that influence what and how work is done) in patient care and nurses' interpersonal and professional interactions in Ghana.MethodsData for the study was obtained through 5 months of ethnographic participant observations and interviews with 11 nurses, 11 family caregivers, and 21 patients. All interviews were audio-recorded and transcribed. Field notes were handwritten and later typed. All data were manually coded inductively and analysed thematically and through institutional ethnography, yielding four interrelated themes: physical design and layout of nurses' stations, nurse station design and patient care coordination, nurses' interpersonal relationships, and collaborative care and information dissemination.ResultsThe study found that nurse station design influenced patient security and safety, quick response to patient needs, and close interaction between nurses and patients/family caregivers, thereby likely reducing nurses' travel distance to engage with patients/family caregivers. Furthermore, it encouraged peer education, shared learning, strong interpersonal and professional relationships, and collective dialogue among nurses within the same patient unit. However, these interactional patterns and ruling relations were not solely due to the nurse station design architecture but were text-coordinated.ConclusionThere is an imperative for further research to understand how nurse station designs and institutional texts mediate nurses' collegiality, nursing leadership, and nurse-student nurse clinical interactions in both teaching and research hospitals.
Simulation-based education (SBE) is increasingly used in health-care training, offering nursing and midwifery students hands-on experiences in realistic controlled environments. This study examined the views of educators, clinical instructors, and final-year students in Malawi, where limited research on SBE exists. Using a descriptive qualitative approach, data were collected through interviews with 35 educators and clinical instructors and focus group discussions with 91 students from hospitals and academic institutions. The findings revealed that SBE enhanced comprehensive skill development, encouraged teamwork in multidisciplinary settings, and improved knowledge retention through repetition and reflection. Participants emphasized that SBE built students' self-confidence by allowing them to learn from mistakes in a safe space, thereby reducing clinical errors. Simulation-based education was seen as a cost-effective, practical tool that supported the development of both technical and nontechnical skills essential for health-care practices. This study underscores the significant role of SBE in preparing students for real-world clinical challenges and advocates for its broader adoption in nursing and midwifery curricula across Malawi to strengthen health-care education and service delivery.
This issue of Creative Nursing has a theme of Sparking Creativity to Ignite Transformation in Nursing. Most of these 17 articles by authors from Canada, Greece, India, Italy, Japan, New Zealand, Portugal, Sweden, and the United States have already been published Online First. Some didn’t fit closely with themes of recent or upcoming issues, but all are of a quality and with such compelling messages that we are proud to have them in our journal. There are many different kinds of articles. Some report modest studies or projects, others review relevant literature on a particular topic, and still others address sweeping issues in nursing. But all of them have one thing in common: the spark of creativity that led us to accept them for publication in our journal called Creative Nursing. This editorial summarizes each article to reveal that spark.
IntroductionUndocumented students face systemic and personal challenges in pursuing nursing education, particularly within the current sociopolitical climate. The purpose of this narrative review of the literature is to explore strategies to foster inclusive and supportive learning environments for undocumented nursing students.MethodsA systematic search of the literature was conducted to explore the experiences of undocumented college/university students and college/university nursing students. A narrative synthesis approach was used to categorize the findings into themes.ResultsThe literature on the broader population of undocumented college students highlights several key themes that shape their educational experiences and interactions with institutional support systems. These themes include the distinction between undocu-friendly and undocu-serving institutions, barriers to academic and mental health services, legal vulnerability, psychosocial well-being, the dual role of family as both a source of support and stress, and the advocacy and navigational strategies students employ to persist in higher education.ConclusionThe literature review revealed a significant gap in the literature regarding undocumented nursing students. Actionable recommendations are made for building undocu-affirming practices within nursing programs.Clinical RelevanceSupporting undocumented students promises to increase success in nursing degree achievement and promote higher education goals in a previously underrepresented population.
This qualitative descriptive study explored how 26 nurses practicing in diverse settings across the United States experienced, understood, and made meaning of nurse-to-nurse bullying, and how these experiences shaped their workplace culture. Analysis of the results of semi-structured interviews revealed three themes: the normalization of bullying through professional language and early socialization, the acceptance of bullying as a rite of passage tied to power and hierarchy, and the need to intentionally disrupt these patterns through nursing education. Participants described how bullying began in nursing school and continued into their clinical practice, contributing to stress, disengagement, and intent to leave the profession. They also emphasized the responsibility of nursing educators to address workplace climates and to prepare students to respond to bullying through the curriculum. Creating learning environments that emphasize communication, reflection, and relational accountability may help challenge the normalization of bullying and foster more supportive and collaborative nursing cultures.
Objective Clinical mentorship in nursing education is often constrained by insufficient communication, engagement, and structured interaction between students and mentors. This study aims to describe the development and evaluation of a gamified technological prototype, Support, Understanding, Professional Growth, Enhancing Skills, Reflective Practice, Validation, Improvement, Supportive Environment, and Evaluation (SUPERVISE), designed to enhance the mentorship process for nursing students.Methods A user-centered design approach was employed, involving phases of user requirements identification, iterative prototyping, and usability testing. Gamification elements were integrated to support engagement and interaction. Usability testing included 43 participants, comprising nursing students and professionals, who evaluated the prototype using the System Usability Scale (SUS) and open-ended feedback.Results The SUPERVISE application incorporates features such as quizzes, reflective logs, achievement systems, and role-based access to support communication and interaction among stakeholders. The prototype achieved a mean SUS score of 80.8, indicating excellent usability, although some areas for improvement were identified and subsequently refined in later stages.Conclusion The integration of gamification elements enhances the structure and dynamics of the mentorship process, promoting user engagement, feedback, and interaction. SUPERVISE demonstrates strong acceptability and potential as a supportive tool for mentorship in nursing education. Further research is needed to assess its long-term impact and scalability.
Background With the growing integration of artificial intelligence (AI) tools like ChatGPT in education, it is essential to understand how nursing students perceive and utilize such technologies. Their knowledge and attitudes can influence how effectively these tools are used in academic and clinical settings. This study aimed to assess the level of knowledge regarding ChatGPT among nursing students, identify and rank perceived benefits and barriers, and determine associations between knowledge and sociodemographic variables. Methods A descriptive cross-sectional survey was conducted among 244 nursing students at Sum Nursing College, Bhubaneswar, Odisha, India, using a structured sociodemographic and background data questionnaire, a rating scale for perceived benefits of AI, and a checklist to identify barriers to use of AI. Knowledge levels were categorized based on median scores; associations with demographic variables were analyzed using the chi-square test. Results Of 244 participants, 53.7% had poor knowledge of ChatGPT, while 46.3% demonstrated good knowledge. Enhancing student creativity was ranked as the top benefit (77.2%), followed by clarification of doubts and influence on nursing knowledge. The most significant barrier reported was affecting cognition and thinking ability (62.3%). Significant associations were found between knowledge levels and age, geographical location, and socioeconomic status, while gender was not significantly associated. Conclusion More than half of the nursing students had limited knowledge about ChatGPT, despite recognizing its potential benefits. There is a need for targeted educational strategies to improve digital literacy, address ethical concerns, and encourage responsible use of AI in nursing education.
Health-care workers are at an elevated risk of anxiety due to their high emotional and operational demands. While social support is recognized as a buffer against psychological distress, little is known about how its protective role differs according to sex, marital status, and departmental setting. A cross-sectional survey was conducted at a regional general hospital in Greece, with 162 health-care professionals. Participants completed the State-Trait Anxiety Inventory and Multidimensional Scale of Perceived Social Support. The data were analyzed using correlation, regression, and PROCESS-based mediation and moderation models. Perceived social support was significantly and negatively associated with both state and trait anxiety. Regression analysis showed that social support was a robust independent predictor of lower anxiety. Female participants reported higher anxiety levels, which was partially mediated by lower perceived support. Marital status moderated the support-anxiety relationship, with divorced individuals benefiting most from support. Departmental differences emerged, with psychiatric staff showing lower anxiety and a stronger protective effect of social support than administrative staff. Perceived social support reduces anxiety among health-care professionals, and the magnitude of its effect is influenced by sex, marital status, and occupational context.
Background Family members of patients admitted to the critical care unit (CCU) often face the challenging task of decision-making concerning treatment options, which could negatively affect their mental status. Visitation restrictions (VRs) for family members based on an infectious disease may contribute to mental distress.Propose This study aimed to examine the differences in anxiety and depression between family members with VRs and those without VRs after making decisions for patients in the CCU.Methods This cross-sectional study employed a questionnaire to collect data on the basic characteristics of the patients and their family members and the presence of VRs during the hospitalization. The Hospital Anxiety Depression Scale was used for the assessment of anxiety and depression.Results Of the 100 family members (68% with VRs), those with VRs reported higher post-decision-making anxiety than those without VRs, even in multivariate analysis. Conversely, post-decision-making depression worsened in family members without VRs compared to those with VRs.Conclusions Family members of patients in the CCU who had VRs reported higher post-decision-making anxiety, whereas those without VRs reported increased depression. Recognizing VR-dependent changes in post-decision-making anxiety and depression in family members could help them manage mental distress.
Background Surgical complications pose a significant risk for older adults (60+ years old) undergoing elective surgery, highlighting the need for interventions to prevent harm. Pre-surgical optimization has been postulated as one method to promote health outcomes before elective surgeries. Creative approaches to pre-surgical optimization are necessary, especially given the shortage of health-care providers. This review examines the existing literature on critical elements of pre-surgical optimization that older adults can effectively self-manage as well as the best methods to design resources to empower older adults to self-optimize prior to surgery. Methods An integrative review was conducted by searching literature indexed in Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, and Scopus. Results Two themes emerged from the analysis of 22 empirical studies: 1) critical elements of pre-surgical optimization for older adults, and 2) effective strategies for educating and preparing older adults for surgery. Additionally, six subthemes were identified. Conclusion Evidence-informed self-guided pre-surgical optimization resources for older adults should be developed to prevent surgical complications among older adults.
This study investigated the relationship between health information-seeking behavior (HISB), digital health literacy, and fear of COVID-19 among Greek nursing staff during the pandemic. Utilizing a cross-sectional design grounded in Wilson's Model of Information-Seeking Behavior, a structured questionnaire was administered to 120 licensed professionals at a regional general hospital. The primary objective was to examine how informational needs and literacy levels correlated with psychological responses, specifically the fear of the virus. Results indicated that nursing staff were highly motivated to seek information regarding COVID-19 treatments and patient protocols. Younger and less experienced staff favored official sources, such as journals and formal training. While overall levels of fear of COVID-19 were generally low, significant variations emerged based on demographics; male staff and those aged over 51 reported higher anxiety. Furthermore, fear of COVID-19 was found to be negatively correlated with satisfaction with available information. These findings emphasized the necessity of empowering digital health literacy and tailoring informational resources to mitigate fear and enhance professional preparedness during public health crises.
Background Publicly funded health services face persistent challenges in meeting demand for specialty care, particularly in rhinology. Task shifting-the redistribution of clinical tasks from specialists to trained non-specialists-may offer a strategy to optimize health-care delivery. This study evaluates the outcomes of a nurse-led assessment pathway within an outpatient rhinology service in New Zealand.Methods To address increased demand for rhinology services, a registered nurse (RN) at Waikato Hospital was trained to perform initial assessments for patients referred for undifferentiated chronic nasal symptoms. We describe outcomes of this approach over the initial 18-month period.Results A total of 309 patients were assessed through the nurse-led pathway. The average wait time from referral to assessment decreased when compared to the specialist-led clinic. Most patients were discharged with a treatment plan that did not require specialist care. Patient feedback indicated high satisfaction with the nurse-led consultation.Conclusion Task shifting offers a promising solution to address resource constraints in publicly funded health-care systems. Nurse-led assessments can enhance efficiency and optimize care delivery without compromising quality. These findings suggest that task-shifting may be broadly applied to improve outcomes in other resource-constrained health-care settings.
Aims This study aimed to map and analyze scientific evidence on nursing interventions to welcome the families of critically ill patients. Design Scoping review. Data Sources In January 2024, a comprehensive search of studies published between 2018 and 2024 was conducted across the following databases: PubMed; MEDLINE Complete; Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete; Cochrane Central Register of Controlled Trials; Cochrane Database of Systematic Reviews; and MedicLatina. Review Methods The framework proposed by Arksey and O'Malley guided the scoping review and was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist. Results A total of 827 records were initially retrieved and screened. Twelve studies were selected for complete analysis. Nursing interventions for welcoming families of critically ill patients fall into four categories: information provision, emotional support, unit environment adaptation, and family involvement. Conclusion Welcoming families provides a valuable opportunity for early identification of their needs, enabling the establishment of a therapeutic relationship and tailored interventions that support family-centred care. Impact This study highlights the importance of structured nursing interventions in welcoming families to intensive care settings. By addressing families` needs, these interventions contribute to improved emotional stability, family functioning, and potentially better outcomes for critically ill patients.
Background: Frequent callers to emergency medical dispatch centers (EMDC) often have multiple problems, have contact with several care providers, and can be perceived as difficult to help. Purpose: To describe a quality improvement project aimed at enhancing health care for frequent callers. Methods: A project registered nurse (RN) was allocated to coordinate individualized care plans based on identified frequent callers' current problem(s), life situation, and medical history. The outcome was evaluated using an interrupted time series approach and by a review of medical records. Individual interviews were carried out with the project RN and one frequent caller. Conclusions: Most callers were middle-aged or older, more often male, and often lived alone or in a residence. At the time of intervention, frequent callers contacted the EMDC once per week on average and were transported by ambulance 1.4 times per month. Following the project, EMDC contacts and ambulance responses were reduced to 46% and 33%, respectively, of their peak levels.
Nurse health coaching certification is a unique specialty that is being reported in the literature to support health along the continuum of illness to wellness. Board-certified nurse coaches can help clients achieve their health goals. In this article, a nurse coach provided coaching to participants using motivational interviewing techniques. This article describes an intervention in which a nurse provided health coaching to mutual-support dyads of South Asian women. Using technology-based communication and motivational interviewing techniques, the nurse supported participants in working toward their physical activity goals. This article offers a brief overview of the nurse-led health coaching component of the intervention.
Discrimination and violence against women and girls continue to rise globally, and the advocacy spaces confronting these crises are themselves sites of emotional intensity, trauma exposure, and burnout. This quality improvement report describes a nursing-led initiative to cocreate environments of care within the nongovernmental organization (NGO) Commission on the Status of Women (CSW) Forum, a nongovernmental advocacy space that connects civil society and grassroots activists to the official United Nations CSW, one of the world's largest gatherings on gender equality worldwide. In partnership with NGO CSW Forum leaders and community healers, nurses designed and implemented a two-phase restoration initiative that offered respite, somatic regulation, and relational support for delegates and organizers. Guided by Healing Justice, Human Caring Theory, and Human-Centered Leadership frameworks, the project elevates nursing's role as social architects for caring spaces in high-intensity systems and settings. Using participatory codesign principles and value-oriented relationship building, the initiative engaged more than 100 participants over 2 weeks, with feedback highlighting experiences of calm, connection, and renewed capacity to continue advocacy work. Executive leaders rated the initiative as highly valuable and integrated it into the formal forum structure. This case illustrates how nurses can lead care-centered design in global advocacy contexts, using power-with partnerships to address burnout, sustain participation, and model environments of care adaptable across health and social systems.
This paper introduces the Societal Health & Nursing Framework as a sociologically informed approach that expands nursing's focus from individual patients and families to the broader societal conditions influencing health and illness. Grounded in sociology, public health ethics, social determinants of health, intersectionality, and socioecological models, the framework offers nurses a shared language and structure to address upstream drivers of health inequities. Nursing practice is increasingly shaped by social, political, and economic forces that extend beyond individual clinical encounters. Although the International Council of Nurses Code of Ethics affirms nurses' responsibility to promote human rights, health equity, and social justice, these ethical commitments are not consistently translated into everyday practice or education. By situating health within cultural and structural contexts, the Societal Health & Nursing Framework provides a unified vocabulary and conceptual foundation to promote holistic, culturally responsive care and strengthens nursing's role in advocacy, policy engagement, and global citizenship. Integrating this framework into nursing education and practice reinforces nursing's social mandate to advance health equity and societal well-being.
Creative Nursing Volume 32 Issue introduced a new series on Critical Approaches for Nursing Research, with the intention of helping nurse researchers design and conduct research inquiries that are better suited for promoting health equity and dismantling structural inequalities. Critical research, which questions claims of objectivity and exposes the sociohistorical nature of knowledge, remains underutilized in nursing. This second editorial in the series offers an overview of critical qualitative research, its underlying principles, and practical considerations. The next editorials in this series will focus on critical mixed methods research and queer methods.
