As digital technologies and artificial intelligence reshape health care, nursing's humanistic foundations face profound ontological and epistemological transformations. In this paper we analyze the tensions between technological efficiency and relational presence, arguing that "datafication" risks eroding the humanness in clinical care. By synthesizing these tensions through a constructivist lens, we propose the Integrated Dimensions of Technology and Care Framework which positions technological competence and compassionate care as symbiotic, mutually reinforcing dimensions. The framework provides a conceptual structure for improved understanding around how technology and compassionate care can connect in a way that ensures person-centered care remains paramount.

Objective To provide an in-depth understanding of the care processes involving the use of the Long-Term Care Facilities (LTCF) tool in Nova Scotia, Canada. Specifically, this constructivist grounded theory study explored the perspectives of long-term care (LTC) residents, substitute decision-makers (SDMs), and nurses, with the aim of improving residents’ care. Methods A constructivist grounded theory study was conducted in LTC homes in Nova Scotia, Canada, between September 2022 and April 2023. Data were collected through 38 semi-structured interviews with residents, SDMs, nurses, supplemented by 41 field notes and 10 analytical memos. Data were analyzed using constructivist grounded theory methods. Results: The emerging substantive theory was developed primarily from the perspectives of nurses and LTC management, while residents’ and SDMs’ perspectives provided contextual and supportive insights. The participants described InterRAI LTCF care process improvement through relationship-centredness, intentionality, and effective change management. If implemented properly at the point of care, these strategies could facilitate consistent care improvement for LTC residents. Conclusions The findings have important implications for practice, policy, and future research. Care process improvement in LTC settings requires attention to relational, organizational, and technological factors. These implications are particularly relevant for LTC management, point-of-care nurses, and LTCF software designers seeking to enhance the quality and consistency of residents’ care.

Menstrual pain affects over half of menstruating adolescents, and there is a desire for accessible, adjunct treatments, such as behavioural health interventions in mobile health (mHealth) formats. To date, no mHealth apps for adolescents with menstrual pain have been designed with youth. Although user-centred design is best practice, many challenges can arise, particularly when working with industry partners in the design process. We report on the development and usability testing phase of an industry-developed app for adolescents with menstrual pain, along with exploration of challenges and emerging recommendations throughout the process. The user-centred design process was composed of three phases. In Phase 1 we identified an industry partner and established a patient advisory committee. In Phase 2, adolescents (N = 22) reviewed iteratively developed versions of app design and content using a think-aloud procedure, followed by a semi-structured interview. The app was well-received by adolescents, although in each phase, feedback related to (1) visual design, (2) interface design, (3) content, and (4) app features was observed. In Phase 3, research team members and a patient advisor reflected on the process of working with industry. Identified reflections were thematically analysed and an overarching theme of Integration of Research, Industry, Institutional, and Funding Needs was generated, with four subthemes: timeline considerations; genuine patient involvement; financial constraints; and establishing mutual understanding. We provide a checklist of recommendations for working with youth and industry in app design and practical considerations when working with industry partners and adolescent stakeholders are discussed.

Emergency departments (EDs) face chronic crowding and complex patient flow challenges that traditional simulations struggle to capture. Conventional discrete-event or agent-based simulation can match high-level metrics, such as wait time distributions and throughput. However, they cannot reproduce the fine-grained behaviors, communications, and dynamic decision-making of real clinicians and patients. These micro-level interactions are often key to showing ED performance. We propose EDSim, an agentic ED flow simulator that uses large language model (LLM) agents to drive realistic, environment-aware interactions among artificial intelligence agents. EDSim offers a modularized patient journey from triage through treatment and discharge that supports customization, with virtual patients and healthcare providers who converse and make decisions in natural language based on dynamic conditions in the ED. The LLM agents are constrained by clinical rules and global EDstates, enabling both macro-level fidelity and micro-level insight. We have parameterized EDSim with aggregate historical data to reproduce daily arrival patterns and acuity mixes. Results show that EDSim’s baseline outputs align with historical wait time distributions stratified by triage acuity. Moreover, EDSim generates convincing individual conversations and behavior under potentially new workflows. This illustrates a new paradigm for healthcare operations research, combining data-driven agent-based modeling with LLM-generated behavior to provide a realistic, versatile testbed for improving ED operations. We demonstrate how analysts and hospital managers can use our tool to conduct what-if experiments in minutes, such as reallocating beds or staff to uncover bottlenecks and evaluate interventions. Our simulator can be used by both researchers and practitioners to explore ways to improve emergency care delivery.

The integration of artificial intelligence (AI) into healthcare represents a paradigm shift with the potential to enhance patient care and streamline clinical operations. This commentary explores the Canadian perspective on key organizational considerations for nurse executives, emphasizing the critical role they play in fostering the establishment of AI governance structures and advancing the front-line adoption of AI in nursing practice. The discussion delves into five domains of consideration, analyzing recent developments and implications for nursing executives. This commentary helps nurse leaders who are getting started in AI become familiar with necessary information and understand Canada's landscape.

AIM:To provide an in-depth description of an innovative Doctor of Nursing programme which prepares nurses for senior roles in healthcare and related organisations. This programme provides nurse leaders with the knowledge and skills to advance systems through healthcare innovation design, implementation, and evaluation. METHODS:A comparison of doctoral nursing programmes, highlighting the unique aspects of the University of Calgary Doctor of Nursing programme. RESULTS:The University of Calgary Doctor of Nursing programme addresses key gaps that currently exist within nursing education. Few existing programmes directly support the development of nurses as healthcare leaders and innovators. This programme enables nurse leaders to leverage their front-line experience into senior system-level leadership roles. Each core course includes a building block assignment that develops key doctoral skills: framing research questions, appraising literature, selecting methods and data, planning ethically sound projects, and translating evidence into persuasive arguments for policy or system change. CONCLUSION:Nurses play a vital role in healthcare around the world. The University of Calgary Doctor of Nursing programme recognises the value of investing in nursing leaders and emboldening them to leverage their frontline leadership experience to advance data-driven change, innovation, and policy development in the complex healthcare systems in which they work and lead. IMPLICATIONS FOR THE PROFESSION:Currently, there is a dearth of programmes available to prepare nurses for senior leadership roles in healthcare or related organisations, despite significant demand from prospective students and employers alike. The University of Calgary Doctor of Nursing programme meets the workforce demand for a programme focused on nursing leadership, to advance health systems through skill development in systems innovation, appraisal of evidence and implementation science, as well as quality assurance/quality improvement and programme evaluation. This programme focus also better equips students to examine and evaluate systemic inequities and challenges currently facing healthcare systems, practitioners and users.

There is growing demand for user involvement in health information technology (IT) design to ensure that emerging technologies meet the needs and expectations of end users. This scoping review explored the state of nurses’ involvement in health IT design, focusing on the: (1) methods, frequency, capacity, and levels of involvement in the design process; (2) types of health IT systems nurses are included in designing; and (3) outcomes of nurses’ inclusion in the design process. This review followed the Joanna Briggs Institute methodology for scoping reviews. A systematic search was conducted in seven databases: MEDLINE (Ovid), Cumulative Index to Nursing and Applied Health Literature (CINAHL) (EBCOhost), Embase (Ovid), Scopus, Web of Science, Compendex Engineering Village and Institute of Electrical and Electronics Engineers (IEEE) Xplore Digital Library database platforms. A total of 3,364 studies were screened at the title/abstract phase. After initial exclusions, 632 articles were screened for full texts, 495 were excluded, resulting in a final set of 137 eligible articles. Included studies most frequently involved nurses as users or testers of the technologies – usually at the end stages of the design process. Most studies interchangeably used the concepts of human-centred design and user-centred design to guide the design process. Interviews, surveys, observations and think-aloud techniques were the most frequently used design methods to elicit nurses’ perspectives about health IT systems. However, it was unclear which methods or approaches were most effective in engaging nurses in the design process. No standardized or validated nurse engagement frameworks were reported. These findings highlight the need to explore the nature of nurses’ involvement in design, their preferences in engagement and specific contributions and roles in order to develop an evidence-based approach to guide nurses’ participation in the design process. Nurses are rarely involved in health IT design, particularly in the early design stages. Failure to involve nurses in early stages can lead to IT systems lacking specific nursing contents, functionalities, and technical features, which may affect the use of the systems for nursing work. In this study, we found evidence of nurses being included at the end stages of the design process. Despite majority of the studies focusing on health IT design and development, nurses were mainly involved as users or testers of the technologies. In other words, nurses were mainly engaged in usability testing activities, which typically occur at the end of the design process rather than upstream design phases. We found that the concepts of human-centred design and user-centred design used interchangeably. At the end of the design processes, nurses perceived the IT systems as acceptable and usable, and either integrated or willing to integrate into clinical practice. Nurses perceived satisfaction with the design process resulting from effective technologies highlight the importance of engaging them in every stage of the design process. Our findings suggest that nurses have potential to leverage their clinical expertise and practical understanding of nursing workflows to guide health care technology design processes.

The integration of digital health and informatics competencies into health care education in Canada is essential for preparing a workforce capable of leveraging health care technologies to enhance care delivery and patient outcomes. Despite significant advancements, the current educational landscape in digital health remains inconsistent, characterized by fragmented curricula and uneven competency attainment. Addressing these gaps requires an innovative reframing of digital health competencies guided by a robust, outcomes-oriented framework. These authors propose the Quintuple Aim as an effective framework for outlining and organizing digital health and informatics competencies, focusing simultaneously on improving patient experience, enhancing population health, reducing health care costs, improving health care provider experience, and advancing health equity. Each dimension of the Quintuple Aim provides a critical lens for identifying, prioritizing, and contextualizing core competencies. Within the "patient experience" aim, competencies prioritize patient-centered technology use, including digital literacy, privacy awareness, and the ability to empower patients through technology. "Healthcare provider experience" competencies prioritize usability, workflow integration, and strategies to mitigate technology-related burnout. Under "population health," competencies emphasize data-driven decision-making, analytics, and health informatics to support effective public health interventions. Competencies associated with "cost reduction" focus on operational efficiency, resource optimization, and economic evaluation of digital health solutions. Finally, "health equity" competencies emphasize inclusivity, cultural safety, and the elimination of digital divides, ensuring equitable access to digital health technologies. Potential assessment strategies aligned with each competency area are highlighted, emphasizing formative and summative evaluations that include simulation-based assessments, real-world technology integration projects, and reflective practice portfolios. By applying the Quintuple Aim as a guiding structure, digital health education can achieve greater standardization, clarity, and alignment with health care system needs, while simultaneously allowing for tailored adaptations responsive to specific regional and institutional priorities. This paper introduces the Quintuple Aim as a guiding framework to comprehensively identify and organize core digital health and informatics competencies for health professional education.

Objectives To examine longitudinal trends and identify key indicators of nursing workforce shortages across Canadian provinces and territories using publicly available data.Design Retrospective ecological study.Setting Primary and secondary care in Canada. National data were extracted from Statistics Canada and the Canadian Institute for Health Information (CIHI) between 2015 and 2022 at the provincial and territorial levels.Participants The study included registered nurses and registered psychiatric nurses employed in the Canadian healthcare system. Licensed practical nurses and nurse practitioners were excluded. Territories with missing data were excluded from the analysis.Primary and secondary outcome measures The primary outcome was nursing workforce shortage, assessed in relation to potential indicators, including the nurse-to-population ratio, job vacancy rate and annual costs of overtime work, using structural equation modelling (SEM).Results The Canadian nursing workforce grew by 8.0%, with the nurse-to-population ratio increasing from 11.08 to 12.13 per 1000 population. Job vacancies rose by 6.4% (95% CI: 6.29 to 6.51%), overtime hours increased by 13.09 million (95% CI: 10.28 to 15.87) and yearly overtime costs rose by 0.78 billion CAD (95% CI: 0.64 to 0.92). SEM revealed significant associations between workforce shortage and the nurse-to-population ratio (standardised β=0.863, 95% CI: 0.942 to 0.975), job vacancy rate (β=0.958, 95% CI: 0.927 to 0.990) and yearly overtime costs (β=0.983, 95% CI: 0.967 to 0.999). Predicted shortage scores were lower before 2020 but increased significantly after 2020, potentially reflecting the impact of COVID-19 pandemic.Conclusions Despite growth in the nursing workforce, increasing job vacancies, overtime hours and costs highlight persistent shortages. Monitoring these indicators is essential for effective workforce planning and sustainable healthcare delivery.

The influence of artificial intelligence (AI) is driving transformation in healthcare systems in parallel with similar disruption in other sectors and society at large. In this article, we draw on Kueper and Pandit's (2025) paper to emphasize that this global infusion of AI requires immediate attention from the world's largest group of healthcare practitioners. Nurses have a critical role to play not only in how this technology will change healthcare delivery and their professional practice but also in how it will change the world. Promising nursing-led AI initiatives include improved clinical decision making and prediction, personalized care, digital documentation and resource allocation.

RationaleDetermining the ability of a country’s nursing workforce to meet the health care needs of the population is essential for optimal health outcomes. ‘Nursing shortage’ is frequently heralded as an issue, yet it is unclear how ‘shortage’ is defined and calculated. The purpose of this study was to collect and link publicly available Canadian data to describe and compare trends in nursing workforce capacity. MethodsPrimary data sources included linking Statistics Canada and Canadian Institutes of Health Information (CIHI) data from 2015 to 2022. Statistics Canada tracks provincial population data and job vacancy rates. CIHI receives data from provincial nursing organizations on demographics, roles, and employment status. To estimate a sufficient workforce, job vacancy rates (a proxy for provincial need) were cross tabulated with the number of registered nurses (RNs) and registered psychiatric nurses (RPNs) per year. ResultsThe number of RNs and RPNs in Canada has increased by 8.6% between 2015 and 2022, to a total of 322,226. Job vacancies, as a percent of total nursing supply, shows a rising trend (2.3% to 8.7%) between 2015 and 2022 across Canada. In 2022, 84.9% of Canadian RNs and RPNs in direct patient care across Canada and 86.1% were in urban settings. Conclusion & LimitationsThis project examines Canadian nursing workforce data encompassing potential effects of the COVID-19 pandemic. The trends are limited to annual due to aggregated data. Data on a country’s nursing workforce measured monthly and consistently across provinces would yield clearer information.

BackgroundDespite the growing adoption of digital health tools as a means to support mental health, many individuals remain unaware of the variety of mental health resources available to them through this format. To address this knowledge gap, this study advanced the design, development, and implementation of a text-based service called SaskWell to raise awareness of evidence based mental health resources and create more immediate connections to these tools. The two primary objectives of the study were to assess and evaluate the adoption of SaskWell by focusing on user acceptance, satisfaction, and perceived benefit, and to identify factors which contributed to user engagement with the SaskWell text-based service. Both quantitative and qualitative data contributed to the final study results.ResultsThis study utilized a co-designed text-messaging service to provide residents of Saskatchewan an important connection to digital mental health and wellness resources during the height of the COVID-19 pandemic. Using the RE-AIM framework as an implementation guide, four distinct cycles of SaskWell were delivered with modifications to the service in each subsequent cycle based on user engagement, feedback, and the direction of a community advisory group. Quantitative data was collected through user engagement text message response data, along with enrollment and exit surveys, while semi-structured interviews served as the primary means of qualitative data collection. In addition to the quantitative user data, these user interviews resulted in themes exploring motivation to sign-up for the service, perceptions of texting as a mechanism to deliver mental health resources, the impact of SaskWell on mental health and well-being, and beliefs on the future potential of text-based mental health supports.ConclusionsBoth the user engagement survey and the qualitative data supported the worth of ongoing efforts to refine and extend the use of text messaging as a means to engage citizens around the awareness and use of digital mental health and wellness resources. As the pandemic has receded into the background in many peoples' daily lives, for healthcare providers, and others who continue to be impacted more heavily by the persistent challenges of this global event, this type of service may continue to be timely.

Background Improving self-efficacy for nursing students to manage aggressive behaviours in clients with dementia supports better outcomes for clients. No studies have been conducted on the use of immersive virtual reality as a potential tool. Method A mixed-methods, randomized control trial explanatory design compared perceived self-efficacy for practical nursing students who used the CareGiVRTM virtual reality application with those who did not, using the Inventory of Geriatric Nursing Self-Efficacy (IGNSE) along with qualitative focus groups. Results Forty-six students (49%) participated in the quantitative component. Fifteen students elected to participate in the follow-up qualitative focus groups. Findings indicate participants who used the CareGiVRTM application reported statistically significant higher levels of perceived self-efficacy post-intervention and when compared with those in the control group following their clinical rotation. Four themes were identified: getting real-world experience, a safe place to practice, meeting the client where they are at, and a tool not a replacement. Conclusion Immersive virtual reality can be an effective tool to increase perceived self-efficacy for managing aggressive behaviours in clients with dementia in practical nursing students.

BACKGROUND:Donor human milk is recommended when infants are unable to be fed their mother's own milk or require supplementation. For-profit companies use technologies to create human milk products for infants in the neonatal intensive care setting without consistent guidelines and regulatory frameworks in place. This commercialization of human milk is inadequately conceptualized and ill-defined. RESEARCH AIMS:The aim of this study is to conceptualize and define the commercialization of human milk and discuss the need for policy guidelines and regulations. METHOD:Using a concept analysis framework, we reviewed the literature on the commercialization of human milk, analyzed the antecedents and potential consequences of the industry, and developed a conceptual definition. The literature review resulted in 13 relevant articles. RESULTS:There has been a surge in the development and availability of human milk products for vulnerable infants developed by for-profit companies. Commercialized human milk can be defined as the packaging and sale of human milk and human milk components for financial gain. Factors contributing to the commercialization of human milk include an increased demand for human milk, and consequences include potential undermining of breastfeeding. The lack of guidelines and regulations raises concerns of equity, ethics, and safety. CONCLUSION:The industry is rapidly growing, resulting in an urgent need for consistent guidelines and regulatory frameworks. If left unaddressed, there could be potential risks for donor milk banking, the future of breastfeeding, and infant and maternal health.

Background Virtual reality is an emerging technology for nursing education. This technology can provide visual, motor, and auditory immersion into a virtual environment, thereby mimicking reality. Virtual reality may be an effective pedagogical tool for nursing educators to meet the learning needs of nursing students. Objective The aim of this scoping review was to map the existing literature on the use of immersive virtual reality implemented within nursing education programs with nursing students. Design Scoping review following established methodology. Data sources A database search of ERIC (OVID), Medline (OVID), PubMed, Web of Science, and CINAHL Plus with Full Text, and Nursing and Allied Health Database. Records published between January 2010 and August 2022. Review methods Two reviewers independently screened titles and abstracts of 2115 articles. Fourteen articles were included in this scoping review. Results Five major themes were identified in the thematic analysis: Self-confidence, Skill acquisition, Improved learning outcomes, Perspective taking, and Promoting engagement. Immersive virtual reality is being utilized in a variety of clinical settings and with different intended purposes. Most virtual reality research is focused on end-user satisfaction and perceptions of usability. Conclusions This scoping review provides a comprehensive understanding of the use of immersive virtual reality within nursing education. There is a range of definitions of virtual reality utilized within nursing literature. Further research is necessary to study this growing area of technology for nursing education.

Abstract Canada has one of the highest rates of inflammatory bowel disease (IBD), with older adults as the fastest-growing group of individuals affected. This exploratory mixed methods study aimed to understand perceived health-related quality of life and care experiences in older adults with IBD. Participants greater than 60 years of age, who were diagnosed with IBD, and who lived in Saskatchewan, Canada were invited to participate in both an online survey and telephone interview. Seventy-three respondents completed the survey, and 18 participants were interviewed. Most individuals were diagnosed before age 60, believed their IBD was well controlled, believed their current treatment was useful, and were satisfied with their care. Individuals also reported a moderate health-related quality of life. However, collaborative management of IBD care between providers and older adults with IBD was identified as an area with room for improvement. Strategies to enhance disease self-management and engaged chronic illness care are critical.

Artificial intelligence (AI) is driving global change. An AI language model like ChatGPT could revolutionize the delivery of nursing education in the future. ChatGPT is an AI-enabled text generator that has garnered significant attention due to its ability to engage in conversations and answer questions. Nurse educators play a crucial role in preparing nursing students for a technology-integrated healthcare system, and the emergence of ChatGPT presents both opportunities and challenges. While the technology has limitations and potential biases, it also has the potential to benefit students by facilitating learning, improving digital literacy, and encouraging critical thinking about AI integration in healthcare. Nurse educators can incorporate ChatGPT into their curriculum through formative or summative assessments and should prioritize faculty development to understand and use AI technologies effectively. Collaboration between educational institutions, regulatory bodies, and educators is crucial to establish provincial and national competencies and frameworks that reflect the increasing importance of AI in nursing education and practice. It is paramount that nurses and nurse educators be open to AI-enabled innovations as well as continue to critically think about their potential value to advance the profession so nurses are better prepared to lead the digital future.