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Updating recent reviews and enriching the available evidence with expert opinions on the challenges and expected reforms needed in doctoral education across Europe.
A dual design based on a rapid review and an online survey.
The PubMed, CINAHL and Scopus databases were searched for studies published between January 2020 and June 2025 using the terms “PhD” AND “nursing”. In parallel, an online survey with open-ended questions was distributed to a purposive sample of academic experts in each European country. Findings from the literature were juxtaposed and integrated with the data from the expert survey and integrated.
A total of 23 studies and 26 expert opinions. Doctoral nursing education in Europe is facing seven key challenges regarding: (1) institutions and their structure, (2) supervision, (3) candidates, (4) research process and outcomes, (5) professional development and career progression, (6) international collaboration and (7) paradigm-related concerns. Six anticipated changes/recommendations were identified in (1) structural and policy reforms, (2) supervision and mentoring, (3) candidate recruitment, retention and support, (4) financial and institutional support, (5) professional development and career recognition, (6) collaboration and internationalisation. While some challenges and changes were confirmed by the literature, others emerged from the experts' insights.
Complex challenges are faced by European doctoral nursing education, some under-researched as issues of supervision and candidate experience. Strengthening structures, mentorship and international collaboration is essential to align education with academic standards and healthcare needs.
Efforts are needed at the European level to strengthen doctoral education in nursing to ensure well-prepared academic and clinical nurses.
Findings may support in the development of more cohesive and high-quality doctoral nursing programs across Europe and inform targeted reforms.
The rapid review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.
This study did not include patient or public involvement in its design, conduct or reporting.
To describe the factors that characterise nursing programs that continue to attract a high number of applicants even though the total number of applicants is declining.
A qualitative embedded case study in Italy on 2025.
A purposive sample of four undergraduate nursing programs for which there were more applicants than places in the last three academic years, compared to the rest of the macro-region, where an average ratio of 0.8 applicants/place was documented. Key informants (dean, clinical practice coordinator, nurse educators, students) from each program were involved. A semi-structured, open-ended interview was conducted focusing on the factors that make the identified nursing programs attractive. The recorded interviews (n = 19) were analysed thematically by triangulating the data. A member check was also conducted.
Five factors make a nursing program attractive: (1) the strategic location of the university, (2) the reputation and influence of the nursing program, (3) the structured, innovative, and open-oriented nursing curriculum, (4) the quality of the tutorial system and (5) the program's commitment to student support and development.
Even in times of declining enrollment and fewer applicants, certain factors can make a nursing program magnetic.
The map of emerging factors can serve as a strategy to help nursing programs attract students and improve their overall appeal.
What problem did the study address? ○
In some countries, there is a downward trend in applicants to the nursing profession, raising serious concerns about the growing global nursing workforce gap.
○With the decline in applicants, the long-term sustainability of nursing programs is also at risk.
○No study has investigated the factors that characterise nursing degree programs, which attract even more applicants in a context of declining attractiveness.
What were the main findings? ○
Five magnetic factors have emerged, one of which is external and the others internal to the nursing program.
○The external factors relate to the program itself—and are embedded in the social, civic and academic environment of the host university and the city.
○The internal factors relate to the strong leadership and commitment of the nursing programme to promote its quality.
Where and on whom will the research have an impact on? ○
Findings may inform actions at the policy, university and individual nursing program levels.
COnsolidated criteria for REporting Qualitative Research Checklist.
Data collection and validation involved citizens (students) attending the identified nursing programs.
To analyse the impact of a participatory process of awareness and reflection on compassion, in the face of end-of-life processes, in students aged 12–23 years in six Spanish regions, and to understand how the participatory process can transform their compassion.
Mixed sequential transformative methodology with different phases. In the first phase, a prospective quasi-experimental design with evaluation pre-post in a single group will be adopted. The second phase is the intervention under study, which will consist of a Participatory Action Research with concurrent evaluations.
In the quantitative phase, 1390 students aged 12–23 from a Public University and a Public Secondary Education Institute across six different Spanish regions will be included. A single questionnaire will be administered before and after the Participatory Action Research to contribute to the process evaluation, incorporating four scales (compassion for others' lives, Death Anxiety Scale, basic empathy modified for adolescents and self-compassion). Responses will be recorded in the Research Electronic Data Capture system. For data analysis, comparison groups, change evolution and associations between variables will be examined, along with multivariate logistic regression models. In the qualitative phase of participatory action research, a promoter group will be established in each university and secondary school in every region. Qualitative data will be analysed following the authenticity, transferability, auditability and neutrality criteria. Discourse analysis triangulation will be conducted to achieve data saturation.
Implementing participative action research in the educational environment to improve students' compassion makes them capable of founding compassion communities to help those who have a terminal illness.
This study will adhere to the relevant EQUATOR guidelines, such as the Good Reporting of a Mixed Methods Study guideline, to efficiently report its results through the different steps of this mixed-methods study.
Participatory action research is a method that enables participants to act as researchers of the phenomenon under study, facilitating the immediate application of results within the context. Although students did not participate in the writing of the proposal grant or the research design.
This study registered on Clinical Trials (NCT06310434), was initiated in January 2024, and it will continue up to December 2026.
This multicentre study will contribute to the nursing community with an overview of compassion for those at the end of their lives among young people and provide the knowledge needed to cultivate compassion at universities and schools.
Implementing compassion programmes and death education in the educational environment will empower students to create a compassionate community. The double evaluation of the process will contribute to the qualitative databases.
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