IntroductionWisdom is frequently invoked as a hallmark of good nursing, yet its meaning and practical implications remain conceptually under-specified. Grounded in virtue ethics and the Aristotelian notion of phronesis, this paper aims to clarify the concept of "wisdom in nursing care" to support ethically grounded nursing practice.MethodsA concept analysis was conducted using the Walker and Avant method. The literature search was carried out in January 2026 using the PubMed and CINAHL databases, focusing on uses of the concept of wisdom relevant to the nursing profession. Twenty-five publications were included and analyzed to identify multidisciplinary uses, defining attributes, antecedents, consequences, and empirical referents of wisdom in nursing.ResultsThe analysis delineates wisdom as a morally grounded, relational, and practice-based capacity. Defining attributes include deliberation and context-sensitive judgment oriented toward fairness and patient wellbeing; morally informed action (praxis) undertaken for the right reasons; open-mindedness and humility regarding the limits of knowledge; perceptiveness and moral perception of ethically salient features of situations; reflexivity; empathy and moral imagination; emotional regulation; self-awareness; and understanding of others. Antecedents are organized into personal conditions (values, learning orientation, knowledge base, clinical experience, and mentorship) and environmental conditions (context familiarity, situational awareness, and informational resources). Consequences include progression toward expert practice, integration of theoretical and practical knowledge, ethically attentive navigation of uncertainty, and reinforcement of nursing's commitment to human flourishing.DiscussionThis conceptual clarification supports education, leadership, and ethical practice by rendering wisdom more teachable, discussable, and amenable to study in nursing care. The integration of rigor and compassion positions wisdom as both steward and guide of the person within nursing practice.

Background Professional nursing values (NPVs) represent core beliefs and standards guiding nursing practise and decision-making. Understanding NPVs within specific healthcare contexts is essential for workforce development. This study examined NPVs among nurses in Northern Italy, a region with distinct healthcare system characteristics Purpose To explore the distribution and determinants of professional values among nurses. Methods A cross-sectional survey was conducted among registered nurses recruited through the Provincial Nurses' Council of Northern Italy (May–June 2024). Participants completed the validated Italian version of the Nurses Professional Values Scale-3 (I-NPVS-3). Of 6154 invited nurses, 1263 accessed and completed the survey (response rate: 21.0%); 147 met the strict inclusion criteria for the effective analytical sample (effective response rate: 2.4%) Findings Among 1263 respondents (90.5% female; mean age 38.4±10.2 years), the Caring subscale scored highest (M = 4.52, SD = 0.48), followed by Professionalism. Activism scored significantly lower (M = 3.87, SD = 0.64, p < 0.001). The effective analytical sample (n = 147) meeting strict inclusion criteria showed significant gender differences, with male nurses scoring lower overall (average marginal effects: −4.4 points; 95% CI: −7.2 to −1.5; p = 0.008). Discussion Gender- and role-based differences suggest that professional values are not uniformly internalised, potentially affecting leadership, ethics, and team dynamics. Conclusion Findings suggest the need for targeted professional development interventions, particularly mentorship programs and institutional policy engagement structures, to strengthen nursing activism competencies within the Italian healthcare context. Results contribute to international discourse on NPVs across diverse healthcare systems.

Perfectionism is increasingly prevalent among university students, yet its developmental antecedents are less understood. This study examined the perceived origins of perfectionism, early family relationships, self-acceptance, and social influences using the 16-item Roots questionnaire (Family, Self, Social) and explored sociodemographic and educational correlates. In a multicenter cross-sectional survey, 2103 Italian students (mean age = 23.4; 76% female) completed the Roots scale. Nonparametric group comparisons and k-means clustering were applied. Students generally reported strong parental support, trust, and autonomy, and moderately positive social acceptance. Vulnerabilities emerged in self-related domains: fear of failure and self-critical tendencies were comparatively higher. Subscale means were as follows: Social = 5.10, Family = 5.06, and Self = 3.75 (1-7 scale). Younger students and those from southern/insular regions reported greater family support. Women presented more fear of failure and self-criticism. Catholics, especially practicing students, reported higher family acceptance/trust alongside greater inadequacy concerns. Health sciences students showed stronger family and self-related resources than peers in science/engineering. Offsite and private-university students displayed more protective indicators; scholarships were associated with heightened internal pressure despite some protective features. No group differences emerged in Social Relationships overall, and total Roots scores did not differ by offsite status or scholarship. Clustering (k = 2) yielded a profile with weaker protective factors and higher fear of failure (consistent with "mixed" perfectionism) and a profile with stronger family/social support, higher self-worth, and lower self-criticism (consistent with "adaptive" perfectionism). Findings suggest that while family cohesion and social trust buffer maladaptive perfectionism, fragile self-perceptions remain central targets. Interventions fostering self-compassion, autonomy-supportive climates, and constructive error management may preserve adaptive striving while mitigating risk.

Background/Objectives: Sleep health is a key determinant of physical and psychological well-being, yet poor sleep quality remains common, particularly among women. Sociodemographic inequalities and culturally patterned pre-sleep behaviours may contribute to sleep disturbances, but their combined role in Mediterranean populations is still insufficiently understood. This study aimed to examine sleep quality and its associations with sociodemographic characteristics and pre-sleep habits among adult women living in Spain. Methods: A cross-sectional online survey was conducted among 785 Spanish adult women aged 18-64 years. Sleep quality was assessed using the Spanish version of the Pittsburgh Sleep Quality Index (PSQI). Additional questionnaire items collected information on sociodemographic variables and pre-sleep habits, including meal timing, stimulant consumption, physical activity, bedtime routines, screen exposure, and sleeping alone or with company. Data were analysed using chi-square tests, Mann-Whitney U tests, Kruskal-Wallis tests, Spearman's correlations, and principal component analysis. Results: The mean global PSQI score was 7.5 (SD = 3.01), indicating mildly impaired sleep quality overall. Age showed the largest association with global PSQI score (ε2 = 0.052, p < 0.001), followed by income (ε2 = 0.010, p = 0.016). Frequent nocturnal awakenings were the most common sleep disturbance, whereas sleep medication use was uncommon. Older age and lower income were associated with poorer sleep outcomes, including shorter sleep duration, lower sleep efficiency, and higher global PSQI scores. Higher education and health-related training were generally associated with more favourable sleep profiles. Pre-sleep habits such as late dinners, stimulant use, and evening screen exposure were highly prevalent but showed weak and non-significant associations with global PSQI scores. Conclusions: In this cross-sectional sample, poorer sleep quality was associated with selected sociodemographic characteristics, whereas isolated pre-sleep behaviours showed weak or non-significant associations with global PSQI scores. Given the study design and non-probability sampling, these findings should be interpreted as associations and generalized with caution. They may inform future studies and support the development of gender-sensitive, non-pharmacological sleep-health strategies that consider socioeconomic and cultural context.

Introduction : Oral mucositis is a common and debilitating complication in patients undergoing hematopoietic stem cell transplantation (HSCT). Although non-pharmacological interventions are increasingly implemented in supportive care, HSCT-specific evidence remains fragmented. This review aimed to synthesize current evidence on non-pharmacological strategies for preventing and managing oral mucositis in adult patients undergoing autologous/allogeneic HSCT. Methods : A systematic search of PubMed, Embase, and Scopus was conducted for quantitative primary studies published up to August 2025. Two reviewers independently screened the studies, assessed methodological quality using the Joanna Briggs Institute (JBI) criteria, and evaluated the risk of bias. A narrative synthesis was conducted in accordance with the Synthesis Without Meta-Analysis (SWiM) reporting guideline. Results : Twenty-seven studies met inclusion criteria. The non-pharmacological interventions were categorized as (a) oral cryotherapy (OC), (b), low-level laser therapy (LLLT), and (c) other biologically derived or plant-based treatments. OC demonstrated consistent reductions in Grade 3-4 oral mucositis, particularly during high-dose melphalan conditioning. Prophylactic LLLT reduced incidence of Grade ≥ 2 oral mucositis, although parameter heterogeneity was notable. The other treatments demonstrated effectiveness in reducing both severity and duration of oral mucositis. Conclusions Oral cryotherapy and prophylactic photobiomodulation (PBM) demonstrate the most consistent evidence for preventing moderate-to-severe oral mucositis in adult HSCT recipients. Plants-based and biologically derived adjunctive interventions show preliminary promise but require further high-quality trials. Standardized intervention protocols and core outcome reporting are essential to strengthen clinical guidance. PROSPERO registration number: CRD42023482768.

Understanding the interplay between nutrition, lifestyle, and environmental awareness is increasingly critical in shaping effective public health strategies. This study aimed to culturally adapt, extend and validate the nutritional and social health habits (NutSo-HH) scale for use in the Italian context. Cultural adaptation included forward and backward translation, expert review, and pilot testing. In line with current evidence and guidelines promoting health-enhancing and environmentally responsible diets, the Italian version was revised and expanded into the NutSo-HH-Ita inventory, comprising 4 domains: Nutrition and food choices, Nutritional risk behaviors, sustainability and media influence, and lifestyle and wellbeing. Structural validity was examined through confirmatory factor analysis in a sample of four hundred three Italian adults. Construct validity was evaluated through known-group comparisons. Reliability was assessed using McDonald's omega for internal consistency, factor score determinacy coefficients for factor quality, and intraclass correlation Coefficients for test-retest stability. Confirmatory factor analysis (CFA) confirmed the theoretical structure of the inventory, yielding satisfactory to excellent fit indices across the 9 factors (comparative fit index [CFI] = 0.943-0.997; Tucker-Lewis index [TLI] = 0.922-0.994; root mean square error of approximation [RMSEA] = 0.015-0.048). Known-group analyses further supported construct validity. Omega values ranged from 0.51 to 0.80, with highest reliability observed for Environmental awareness (ω = 0.80; FSD = 0.92) and Digital influence (ω = 0.78; FSD = 0.92). Protein sources and Physical activity showed the lowest internal consistency (ω = 0.51 and 0.54, respectively). Test-retest stability was moderate for most factors, except Media influence, Social Habits, and Sleep quality, which demonstrated poor stability. The NutSo-HH-Ita is a valid and contextually relevant inventory for assessing dietary habits, lifestyle, and the sustainability of nutritional choices in the Italian context. It offers valuable support for epidemiological research, public health intervention planning, and the monitoring of nutritional and environmental behaviors.

Background/Objectives: Nurses' engagement in research is essential to strengthen evidence-based practice, knowledge translation, and quality of care. However, individual, organisational, and cultural barriers may limit nurses' participation in research activities. This study aimed to cross-culturally adapt and psychometrically test the Italian version of the Barriers to Nurses' Participation in Research Questionnaire within the Italian cultural and healthcare organisational context, and to explore perceived obstacles to research engagement among nurses in Italy. Methods: A cross-sectional methodological study was conducted. The instrument was translated, back-translated, reviewed by the original instrument developer and an expert panel, and evaluated for content validity by 12 clinical research professionals. Data were collected online between September and October 2024 from 196 nurses working across Italian healthcare settings, including hospitals, university hospitals, IRCCS, primary care, and private hospitals. Exploratory Structural Equation Modelling was used to examine the factor structure. Results: A total of 196 nurses were enrolled in the study. A two-factor structure was identified, comprising Research Resources and Personal Relevance of Research, which explained 35.37% and 25.14% of the variance, respectively. Both factors demonstrated good reliability. The most prominent barrier was the lack of incentive or reward for nurses to engage in research, whereas the least relevant barrier was the perception that research was not interesting or valuable. Greater barriers were reported by younger nurses, those with fewer years of experience, and those without specific research training. Lack of time to conduct research emerged as a pervasive obstacle across the sample. Conclusions: The Italian version of the Barriers to Nurses' Participation in Research Questionnaire provides preliminary evidence of validity and reliability for assessing perceived barriers to research participation among Italian nurses. Owing to the structural modifications introduced during adaptation, the instrument should be interpreted as a culturally adapted and modified Italian version rather than as a direct replication of the original structure. Its use may support organisational diagnosis, research mentorship, training planning, and future research-capacity-building initiatives, although further validation in larger and more heterogeneous samples is warranted.

Background Family members play a crucial role in palliative care; however, their perspectives on care quality remain underexplored. This limits a comprehensive understanding of how they contribute to defining and evaluating quality of care, despite their potential to enhance support for both patients and families. Aim To synthesize qualitative evidence on family members’ experiences of palliative care and identify the elements they perceive as indicators of high‐quality care. Design A meta‐aggregation was conducted following Joanna Briggs Institute guidelines and registered with PROSPERO (protocol CRD42024560664). Data Sources Systematic searches were conducted in PubMed, CINAHL, PsycINFO, Scopus, Web of Science, and the Cochrane Library from database inception to March 2026. Results Family experiences highlight that high quality palliative care combines clinical skills and empathy, addressing physical, emotional, and spiritual needs. Welcoming, well organized environments, along with trusting relationships between patients, families, and healthcare professionals, are crucial for meaningful care and lasting emotional support. Conclusions This meta‐aggregation highlights the importance of a care model that combines clinical competence with human connection. Empathy, trust, continuity, and supportive environments are important for delivering high quality of care in person‐centered palliative care. Family perspectives are instrumental in promoting compassionate and effective care practices.

Background: Perfectionism is a multidimensional disposition marked by exceptionally high standards and self-worth contingent on flawless performance. In university settings, academic demands may amplify perfectionistic pressure, with maladaptive outcomes most consistently linked to socially prescribed expectations and self-critical failure processing. This study profiled perfectionism dimensions in Italian university students and examined their associations with perceived relational and self-related correlates (Roots). Methods: A multicenter cross-sectional study was conducted with Italian university students. Participants completed two validated tools: the 14-item Multidimensional Perfectionism Scale-Revised (MPS-R) and the 16-item Roots questionnaire. Descriptive statistics, Spearman correlations, and non-parametric group comparisons were performed. Results: Self-oriented perfectionism was the most prominent dimension, while socially prescribed perfectionism (SPP) was comparatively lower but showed the clearest links with vulnerability-related correlates. Lower perceived parental and interpersonal trust was associated with stronger failure-based self-appraisals and perceived excessive demands from others. Higher SPP was observed among women and younger students and in more evaluative study contexts. Conclusions: Perfectionism in this sample was predominantly self-directed, yet risk-relevant profiles were characterized by SPP and self-critical failure processing in conjunction with lower perceived trust/acceptance. These findings support screening approaches that move beyond global scores and inform prevention strategies targeting fear of mistakes, contingent self-worth, and perceived evaluative pressure to promote student well-being. Longitudinal and intervention studies are needed to test temporal pathways and scalable, targeted prevention strategies.

BACKGROUND CONTEXT:Chronic low back pain (CLBP) is a multifactorial condition and a leading cause of disability worldwide. Among the various contributors to symptom persistence, sleep quality has emerged as a critical yet underexplored factor. Evidence suggests a bidirectional relationship between poor sleep and pain intensity, disability, and psychological distress in individuals with CLBP. PURPOSE:To explore the relationship between sleep quality and CLBP using machine learning techniques, specifically the Self-Organizing Map (SOM) algorithm, while accounting for demographic, clinical, psychosocial, and occupational factors. STUDY DESIGN/SETTING:This was a cross-sectional study conducted at Campus Bio-Medico Hospital Foundation in Rome, Italy, between July 2024 and January 2025. PATIENT SAMPLE:The study included 279 adult working patients (aged 18-65) with a clinical diagnosis of CLBP due to degenerative causes, all of whom were candidates for conservative treatment. Patients with cancer, trauma, spinal deformities, or infections were excluded. OUTCOME MEASURES:Pain intensity was assessed using the Visual Analog Scale (VAS), while sleep quality was measured with the Pittsburgh Sleep Quality Index (PSQI), a validated tool capturing various dimensions of sleep disturbance. Disability related to low back pain was evaluated using the Oswestry Disability Index (ODI). Depressive symptoms were identified using the Patient Health Questionnaire-2 (PHQ-2). Functional outcomes included assessment of work capacity through the Work Ability Index (WAI) and activity limitations via the Nordic Musculoskeletal Questionnaire, focusing on how often back pain interfered with usual daily activities. METHODS:Validated questionnaires and anthropometric data were collected. SOM, an unsupervised machine learning algorithm, was applied to detect clusters based on multidimensional patient data. Subsequent k-means clustering was used to define patient subgroups. Statistical comparisons between clusters were performed using Kruskal-Wallis and chi-squared tests. Multiple imputation addressed missing data. RESULTS:A total of 4 distinct patient clusters were identified. Cluster 1 included physically active individuals with moderate pain and no depression. Cluster 2 consisted of highly educated women with sedentary jobs and minimal disability. Cluster 3 showed the worst outcomes: high pain intensity, severe disability, depression, and the poorest sleep quality. Cluster 4, composed entirely of men, showed high work ability, good sleep, low pain, and no depressive symptoms. Poor sleep quality correlated strongly with depressive symptoms, high pain, disability, and reduced work capacity. These associations persisted even when sleep was excluded from clustering inputs, confirming its predictive linkage. CONCLUSIONS:Sleep quality is a key determinant in the clinical profile of CLBP patients. Poor sleep is closely associated with worse pain perception, psychological distress, and functional impairment. SOM analysis revealed hidden patterns not captured by traditional methods. Integrating sleep evaluation into multidisciplinary care models may improve outcomes for CLBP patients. Longitudinal studies are needed to clarify the directionality of these effects.

Palliative care (PC) aims to enhance quality of life and alleviate suffering in patients with advanced or degenerative diseases. Oral disorders (ODs) are common among PC patients, often impairing essential functions such as chewing, swallowing, and communication. The use of natural treatments for these conditions appears promising. This systematic review aimed to evaluate the efficacy, acceptability, and potential adverse events (AEs) and oral tolerability profiles of natural products used for managing ODs in patients undergoing PC. We conducted the review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered it in International Prospective Register of Systematic Reviews (protocol number: CRD42024591279). A comprehensive literature search was performed on multiple biomedical databases (PubMed, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Scopus, and Cochrane Library), applying rigorous inclusion criteria. Included studies were assessed for quality using the Joanna Briggs Institute (JBI) Critical Appraisal Tools and the Oxford Centre for Evidence-Based Medicine levels of evidence. Out of 1075 identified records, 7 studies met the inclusion criteria, mostly randomized controlled trials (n = 5) with 522 PC patients. The studies had moderate to high methodological quality (mean = 88.4%, range = 64%-100%). Glycerol, Salvia officinalis, and peppermint mini ice cubes relieved oral symptoms. Glycerol gave rapid, short-lived relief; salvia improved dryness versus saline; peppermint cubes reduced dry mouth and thirst and were preferred. Cannabinoid trials did not prospectively assess ODs but were retained only as contextual evidence on oral AEs/tolerability and the feasibility of the oro-buccal route. Natural interventions may relieve xerostomia and improve comfort, but generalizability remains limited; future randomized trials with oral-specific endpoints, transparent dosing, and longer follow-up are required.

Background/Objectives: Nutritional management is central to the care of patients with end-stage renal disease (ESRD), yet malnutrition often remains under-recognized due to gaps in nursing knowledge and competencies. This study aimed to develop and validate the Nursing Education and Competencies in Nutrition for Patients with CKD in ESRD (NECN-ESRD) questionnaire, designed to assess nephrology nurses’ competencies, attitudes, and practices in nutritional care. Methods: A methodological and cross-sectional design was adopted, following the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) recommendations for instrument development. The process comprised five phases: construct definition and item generation, expert consultation and revision, quantitative content validity analysis, pilot testing, and psychometric testing. Data were collected between August and September 2025 from 405 nephrology nurses across Italy. Exploratory Factor Analyses (EFAs) and Confirmatory Factor Analyses (CFAs) were conducted on split samples (60/40), and key psychometric properties were evaluated. Results: EFA identified a four-factor structure—Recommendations, Attitudes, Practice, and Advanced Competencies—which was confirmed through CFA with good fit indices [Comparative Fit Index (CFI) = 0.995, Tucker–Lewis Index (TLI) = 0.994, Root Mean Square Error of Approximation (RMSEA) = 0.07]. A higher-order model further improved fit (CFI = 0.994, RMSEA = 0.029), explaining 68.2% of variance. Internal consistency was excellent (ω = 0.89–0.96), test–retest reliability showed perfect agreement [Intraclass Correlation Coefficient (ICC) = 1.00], and invariance testing supported equivalence across educational and experience levels. Conclusions: The NECN-ESRD demonstrated strong validity, reliability, and stability, providing a robust and context-specific tool to assess and enhance nurses’ competencies in nutritional care for ESRD patients. Its application can support targeted educational interventions, improve clinical practice, and contribute to enhancing the quality of nutritional care for patients with ESRD within healthcare systems.

Background: Dietary behaviors and lifestyle factors co-occur in integrated profiles that shape cardiometabolic and mental health risk. Sustainable nutrition, particularly plant-forward eating, has become a relevant dimension of dietary quality, yet its adoption varies across population subgroups and may differ by sex. This study examined sex divergences in sustainable nutrition and lifestyle profiles among Italian adults and the potential indirect association of sustainability awareness in the relationship between sex and plant-based diet adherence. Methods: A cross-sectional study was conducted with 1066 Italian adults using the validated Nutritional and Social Health Habits inventory for Italian people (NutSo-HH-Ita) to assess sustainable nutrition and lifestyle factors. Data were analyzed using independent-samples t-tests and Chi-square tests for sex comparisons, mediation analysis to examine the indirect effect of sustainability awareness on the sex-plant-based diet association, and K-means clustering with multinomial logistic regression to identify lifestyle phenotypes and test sex as a predictor of cluster membership, while adjusting for age, education, and income. Results: Women showed higher plant-based diet adherence (Cohen's d = 0.33; 95% confidence intervals (CI) [0.20, 0.46]) and higher sustainability awareness (Cohen's d = 0.14), while men reported higher physical activity (Cohen's d = 0.21). Sustainability awareness was statistically associated with a small indirect component in the association between sex and plant-based diet adherence (p = 0.045). Cluster analysis identified distinct lifestyle phenotypes, and sex independently predicted phenotype membership after covariate adjustment (p < 0.001), with men more likely to belong to a profile characterized by relatively higher activity combined with poorer sustainability engagement and less healthy lifestyle habits. Conclusions: Sex differences in sustainable nutrition are embedded within broader lifestyle phenotypes. Integrating sustainability-related predispositions with behavioral phenotyping may support sex-sensitive prevention strategies and help identify "Active-Low Engagement" male subgroup that could be overlooked when evaluating single behaviors in isolation.

CONTEXT:Chronic cancer-related pain adversely affects patients' physical and psychological well-being. Pain catastrophizing intensifies pain perception and emotional distress, whereas spiritual well-being may provide essential coping mechanisms. The interplay between spiritual well-being and pain catastrophizing in cancer patients is not thoroughly studied. OBJECTIVES:To investigate the relationship between spiritual well-being and pain catastrophizing in cancer patients experiencing chronic pain. METHODS:A cross-sectional observational study was conducted from June 2023 to June 2024 at cancer center enrolling patients with cancer and pain intensity ≥4/10. Participants completed the Pain Catastrophizing Scale and the FACIT-Spiritual Well-being Scale (FACIT-Sp-12) including the domains Meaning, Peace, Faith. Demographic data, symptom burden, and Karnofsky performance status were also collected. A Generalized Additive Model was employed to assess associations between scores of Pain Catastrophizing Scale and spiritual well-being domains, controlling for symptom burden and demographic variables. RESULTS:Ninety-seven patients, mostly male, with gastrointestinal cancer, a mean age of 62.9 years and mean Karnofsky score 44.4 (SD 7.7) completed the study. Higher levels of Peace (β = -1.96, p = 0.004) and Faith (β = -0.99, p = 0.031) were significantly associated with lower pain catastrophizing, while Meaning was not significantly associated (β = 0.87, p = 0.237) . Increased symptom burden was positively correlated with higher pain catastrophizing (β = 0.16, p = 0.005) . The model explained 38.9% of the variance in pain catastrophizing scores (Adjusted R² = 0.389) . CONCLUSION:Spiritual well-being, specifically the Peace and Faith domains, is inversely related to pain catastrophizing in cancer patients. Integrating spiritual care into pain management strategies may enhance coping mechanisms and reduce emotional distress, thereby improving patients' quality of life.

BACKGROUND:Global nursing research investments aim to improve health outcomes, yet the funding-quality relationship remains poorly understood. PURPOSE:To analyze international nursing research trends (2017-2022) across the 29 most productive countries, examining correlations between declared funding and publication quantity and quality. METHODS:AI-enhanced scientometric analysis employed a Python algorithm matching extracted journals for each country's publication to corresponding quartiles (Q1-Q4), using Scimago's 2022 Scopus update. Two quality metrics -the ratio of total citations to total publications (TC/TP) and the proportion of Q1 publications to total publications (Q1/TP)- were correlated. Local Outlier Factor technique enabled outlier detection. FINDINGS:Nursing research demonstrated quadratic growth. The two quality metrics strongly correlated (r = 0.916, p< 0.001). The number of publications declaring funding correlated highly with publication quantity (r = 0.955, p < 0.001), but not with quality (r = -0.077, p = 0.686). The USA led in publication volume, while the UK, and several European nations led in quality. Notable growth occurred in Indonesia, Saudi Arabia, China, Iran, South Korea, and Turkey. DISCUSSION:Findings suggest that while funding drives publication quantity, quality enhancement requires comprehensive investment strategies, including indirect expenses for institutional research infrastructure and capacity building.

This study used Explainable Artificial Intelligence (XAI) with SHapley Additive exPlanations (SHAP) to examine dietary and lifestyle habits in the Spanish population and identify key diet predictors. A cross-sectional design was used, employing the validated NutSo-HH scale to gather data on nutrition, lifestyle, and socio-demographic factors. The CatBoost method combined with SHAP was applied. The sample included 22,181 Spanish adults: 17,573 followed the Mediterranean diet, 1425 were vegetarians, 365 were vegans, and 1018 practiced intermittent fasting. Fish consumption was the strongest dietary indicator, with vegans abstaining and some vegetarians consuming it occasionally. Age influenced diet: younger individuals preferred vegan/vegetarian diets, while older adults adhered to the Mediterranean diet. Vegans and vegetarians consumed less junk food, and intermittent fasters were more physically active. The model effectively predicts the Mediterranean diet but struggles with others due to sample imbalance, highlighting the need for larger studies on plant-based and intermittent fasting diets.

Background/Objectives: Human dignity is an inalienable value central to human rights and ethics. Professional dignity is pivotal to fostering self-esteem, job satisfaction, and high-quality care in nursing. Despite its importance, no validated tool currently exists to measure nurses’ professional dignity in English-speaking contexts. This study aimed to develop and psychometrically test the Nurses’ Professional Dignity Scale (NPDS). Methods: The tool’s development was guided by a theoretical model from a meta-synthesis. A consensus meeting with five nurse researchers identified three core dimensions for the NPDS: Respect, Professional Value, and Appreciation. Nineteen items were initially generated and refined through face and content validity assessments (all item-level content validity indices [I-CVIs] ≥ 0.80; scale-level content validity index/Ave [S-CVI/Ave] = 0.92). Psychometric testing was conducted with 227 nurses across clinical settings in the United States using confirmatory factor analysis (CFA) to validate a three-factor model. Results: The CFA confirmed the three-factor model with acceptable fit indices (CFI = 0.938, TLI = 0.923, RMSEA = 0.069), resulting in the retention of 15 items. The scale demonstrated excellent reliability, with composite reliability coefficients of 0.92 for Respect, 0.82 for Professional Value, 0.93 for Appreciation, and 0.91 for the overall scale. Conclusions: The NPDS is a valid and reliable measure of nurses’ professional dignity, aligning with theoretical frameworks. It captures both status-dignity and condition-dignity aspects, encompassing respect, professional competence, and societal appreciation, offering a multidimensional structure for assessing individual domains and overall scores. The NPDS contributes to advancing nursing research and practice by addressing workplace dignity, enhancing job satisfaction, and fostering supportive organizational environments that recognize nurses’ professional worth. Future studies are recommended to validate the scale in diverse populations and explore its stability over time through longitudinal research. This study highlights the importance of preserving nurses’ dignity in improving professional identity, workplace environments, and patient care outcomes.

Objectives: This study examines the relationship between nutrition, lifestyle habits, and perceived sleep quality in a cross-sectional analysis of 22,181 Spanish adults. Methods: Data were collected between August 2020 and November 2021 using the Nutritional and Social Healthy Habits (NutSo-HH) questionnaire, which assessed variables such as sleep duration, self-perceived restfulness, dietary patterns, and physical activity. Results: Findings indicate that 48.9% of participants sleep 7–8 h per night, while 8.6% sleep less than 6 h. Approximately 50% report frequently feeling rested, whereas 45.4% seldom or sometimes feel rested. Non-parametric Mann–Whitney and Kruskal–Wallis tests with Dwass–Steel–Critchlow–Fligner (DSCF) correction revealed that perceived sleep quality had an average score of 3.39 on a 0–5 scale, with significant differences based on socio-demographic and lifestyle factors (p < 0.001 for sex, age, education, income, and living in a family). Participants with sufficient sleep reported a lower BMI, a higher nutritional index, and more weekly physical activity. A network analysis demonstrated strong clustering between sleep variables and eating behaviors. Although causality cannot be established in this observational study, the results suggest that better sleep is associated with the lower consumption of sugary drinks and ultra-processed foods, as well as improved body image and mental health. Conclusions: These findings highlight the interconnectedness of sleep, nutrition, and lifestyle habits, suggesting that targeted interventions in any of these areas could positively influence the others, ultimately improving overall health outcomes.

Background: Perfectionism is a growing concern among university students, who face high expectations, demanding workloads, and complex academic tasks. These pressures often lead to stress, negatively impacting performance, well-being, and career trajectories. Existing measures of perfectionism and related stress lack focus on their causes and relevance to students. Methods: This study developed and psychometrically tested an inventory assessing the causes (ROOTS), manifestations (MPS-R), and stress (IPSS-R) related to perfectionism. A multicenter cross-sectional online survey was conducted across multiple Italian universities with 469 students. The ROOTS tool was developed, and the MPS and IPSS were adapted following established guidelines. Content validity was examined, and pilot testing was performed. Confirmatory factor analyses tested three-factor models with a second-order factor for each instrument. Construct validity and reliability were also assessed. Results: The ROOTS, MPS-R, and IPSS-R demonstrated strong structural and construct validity, with acceptable reliability. Significant correlations highlighted the interconnectedness of perfectionism’s causes, manifestations, and stress. Conclusions: The Perfectionism Inventory offers a comprehensive tool for identifying causes, manifestations, and consequences of perfectionism in university students. It can help educators and policymakers develop strategies to mitigate its impact on mental health and academic success. Future research should explore its applicability in other populations.

AIM:To cross-culturally adapt and psychometrically test the Italian version of the EPICC Spiritual Care Competency Self-Assessment Tool for clinical nurses (EPICC Tool-It). DESIGN:Multicentre, cross-sectional validation study. METHODS:The 28-item EPICC Tool was translated into Italian and culturally adapted following a rigorous methodology. A nationwide survey was conducted. Psychometric evaluation included content validity, structural validity (exploratory and confirmatory factor analyses), construct validity (known group analysis) and reliability using Cronbach's alpha, McDonald's omega and factor score determinacy. RESULTS:The sample included 725 clinical nurses (76% female, 80% hospital-based), on average 38.7 years old (SD 11.33), with 14.6 years (SD 11.03) of experience. Confirmatory factor analysis supported a four-factor model (Knowledge of spirituality, Attitudes towards spirituality and spiritual care, Knowledge of spiritual care and Skills in spiritual care), with a second-order factor for the EPICC Tool-It. Construct validity was supported through known group analysis, showing score variation based on nurses' experience, education and religiosity. Internal consistency was excellent across all factors and the overall scale. CONCLUSION:A valid, multidimensional instrument is provided to assess spiritual care competencies in Italian-speaking nurses. The EPICC Tool-It is suitable for research and practice, facilitating evaluation of self-perceived competencies and educational effectiveness. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE:The use of the EPICC Tool-It by nursing managers, educators and clinicians is recommended in both clinical and research settings to support education on spiritual care competencies. IMPACT:The EPICC Tool-It sets reliable measurement standards for spiritual care competencies, enhancing holistic care and comprehensive understanding of competencies globally. REPORTING:This study adheres to the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines. PATIENT OR PUBLIC CONTRIBUTION:Patients, service users, caregivers, or the public were not involved in the study. However, nurses as target users of the tool participated in the cultural adaptation and validation process.