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The multifaceted responsibilities borne by clinical facilitators can impose a significant strain on their mental and emotional health and well-being. Within nursing and other healthcare professions, the responsibilities of clinical facilitators extend beyond conventional clinical duties to encompass supervising, facilitating, assessing, and supporting students as they transition into professional nursing practice. There is a need for insights into the well-being of clinical facilitators in the face of demanding work conditions, limited resources, and the emotional toll of patient care. This article critically reviews the literature to determine the current state of mental well-being among clinical facilitators in undergraduate health professions education and how they should be supported.
A scoping review guided the study using the Population, Context, Concept framework with a search string incorporating associated Boolean operators. 233 records were retrieved from eight databases and reviewed according to the inclusion and exclusion criteria. A total of 13 full-text articles were found to be eligible for extraction and analysis.
Major findings resulted in thematising mental health issue characteristics according to high and low job demands and burnout. Literature outlined the causes of mental health issues, including lack of recognition and appreciation, work performance, teaching and learning practices, student characteristics, support structures, and the environment. Recommendations included training, appropriate support systems, workload, guidelines, monitoring, community of practice, and research-oriented support.
Educational institutions must move beyond ad hoc support and implement integrated, strategic initiatives grounded in the principles of the Job-Demand-Control model. Future research should focus on developing and rigorously evaluating multifaceted intervention programmes that address these systemic factors. By investing in the well-being of clinical facilitators, institutions ultimately invest in the quality of future healthcare providers and the safety of the patients they will serve.
This article sets the tone for factors to consider and provides recommendations for educational institutions to better support the mental well-being of clinical facilitators.
Doctoral research in nursing is central to advancing scientific knowledge, strengthening professional identity, and informing evidence-based practice, education, and health policy. Analyzing the thematic content of doctoral theses offers insight into research priorities and national variations in nursing scholarship. Yet, no systematic cross-country analysis has examined the thematic focus of such work.
To explore and describe the diversity and scope of doctoral nursing research themes across eight countries in the Sigma Europe Region, identifying key areas of scholarly focus and shared priorities.
A document-based qualitative study using reflexive thematic analysis, as outlined by Braun and Clarke, to examine patterns of meaning within thesis summaries.
The study included doctoral nursing thesis summaries defended between January 2020 and December 2023, sourced from national and institutional repositories in eight countries of the Sigma Europe Region. A total of 15 repositories (4 national, 11 institutional) were systematically searched, and additional summaries were obtained via direct contact with universities offering doctoral nursing programmes.
Data were collected between September 2024 and February 2025 using predefined inclusion and exclusion criteria. In total, 431 eligible thesis summaries were analyzed following Braun and Clarke's six-phase framework, supported by MAXQDA software for data management and coding.
Thematic analysis identified three overarching domains: (1) foundations of nursing practice and care philosophy, (2) systemic and organizational dimensions of nursing, and (3) clinical innovation and public health impact. Ten interrelated themes emerged, including holistic and patient-centred care; emotional, psychological, and quality-of-life dimensions; communication in healthcare; workforce challenges; transforming nursing practice; maternal, neonatal and pediatric health; digital and virtual health innovations; public health and chronic disease management; and disease management, caregiving, and outcomes. Cross-cutting elements such as cultural sensitivity and resilience spanned multiple themes.
This cross-national synthesis demonstrates the breadth and depth of doctoral nursing research in the Sigma Europe Region. Findings highlight nursing's pivotal role in addressing healthcare needs through innovative, person-centred, and evidence-informed solutions, and underscore the value of international collaboration in shaping resilient, equitable, and future-ready healthcare systems.
To critically examine the policy logic of the EU-funded WHO Nursing Action Initiative and assess its capacity to address the structural drivers of Europe's nursing workforce instability, with a specific focus on retention governance as the missing determinant of sustainability.
Although Europe reports high aggregate numbers of nurses, persistent workforce shortages are driven not by insufficient supply but by systemic governance weaknesses that undermine retention. The Nursing Action Initiative provides the first coordinated, multi-country framework aligned with the WHO's 2023–2030 strategic priorities, yet several structural gaps, including the absence of binding retention metrics, enforceable safe staffing standards, harmonized advanced practice pathways, interoperable workforce intelligence, and mandatory accountability, limit its transformative potential. A shift from production-centric policies to a retention-driven governance architecture is therefore essential.
The Nursing Action Initiative represents an important step toward strengthening European nursing workforce policy, but its success will depend on Member States' willingness to implement structural reforms that ensure safe staffing, protect nurses' well-being, expand autonomous practice roles, and stabilize workforce distribution. Without a robust architecture of retention governance, neither the sustainability of Europe's nursing workforce nor the resilience of its health systems can be assured.
This commentary advances the policy debate by framing retention as the central determinant of workforce sustainability. It calls for urgent political commitment to move the Nursing Action Initiative beyond aspirational coordination and toward enforceable, system-level reform capable of delivering lasting improvements in workforce stability and quality of care across the European Union.
The research investigated the relationship between servant leadership (SL) and innovative work behavior (IWB) among nurses in Pakistan. It also formulates and hypothesizes a serial mediation model, integrating trust-in leadership (TL) and knowledge sharing (KS) as mediated variables.
Nurses' IWBs are critical for improving patient healthcare quality. Despite their significance, scant research has examined how leadership styles, especially SL, can trigger such behavior in nursing. The paper seeks to fill this gap by examining how SL can enhance innovation among nurses, while accounting for the mediating variables of TL and KS within the Pakistani healthcare system.
A quantitative, cross-sectional study was conducted, involving 269 nurses from hospitals in Islamabad and Rawalpindi. A time-lagged approach to data collection was used to reduce common method bias. Confirmatory Factor Analysis (CFA) and Structural Equation Modeling (SEM) were employed to test the proposed hypothesized relationships using SPSS (version 27) and AMOS (version 23).
The hypotheses revealed a significant impact of the constructs. It was discovered that SL has both direct and indirect positive influences on IWB among nurses through TL and KS. Moreover, the findings support high serial mediation, implying that SL has a positive effect on IWB by first building trust, which then leads to knowledge sharing.
The paper contributes to the literature on servant leadership and innovative work behavior by examining mediating mechanisms within nursing teams in Pakistan. The paper also offers practical implications for nurse managers and hospital administrators on fostering a culture of innovation and trust among nurses.
The findings offer actionable insights for nursing management by demonstrating that adopting a servant leadership style can directly and indirectly enhance nurses' innovative work behaviors. By prioritizing trust-building and fostering a culture of knowledge sharing, nurse managers can stimulate innovation, which is critical for improving patient care quality and overall healthcare outcomes.
The rapid integration of digital technologies into academic and professional life has significantly increased screen time and workload, leading to growing concerns about digital fatigue and its impact on mental health. This study employs a qualitative research approach to investigate the perspectives of academic nurses on the effects of digital fatigue on their mental health.
This qualitative study utilized a pre-developed interview schedule to conduct in-depth interviews with 19 academic nurses residing in the northern region of Türkiye. All interviews were conducted online via Google Meet in accordance with participants’ availability and preferences. Participants were identified through snowball sampling based on predetermined inclusion criteria. Interviews continued until data saturation was achieved. The interviews were conducted without audio recording, and the data were collected through detailed field notes. The study data were evaluated using thematic analysis. The study was conducted and reported in accordance with the COREQ checklist.
Data analysis revealed four themes (Multidimensional impact of digital exposure, Social consequences of digital fatigue, Coping and support strategies, Institutional and policy-level challenges) and 11 subthemes (Physical effects, Mental effects, Cognitive effects, Social isolation, Disconnection from reality, Personal physical measures, Psychological measures, Social support, Environmental regulations, Work-life balance challenges, Need for education and awareness).
The study revealed the adverse effects of technology use by nurse academics in the digital age. It was determined that the social lives of nurse academics were negatively impacted by digital exposure, resulting in digital fatigue. It was also found that some nurse academics had difficulty coping with this fatigue. It is recommended to conduct research examining the relationship between the effects of digital fatigue on personality, digital literacy, mental health, and life satisfaction, addressing the impact of digital platforms that cause fatigue, and evaluating users' awareness levels of digital network fatigue. In this context, addressing digital fatigue requires the integration of psychiatric nursing approaches focused on mental health promotion and coping enhancement, together with public health nursing strategies emphasizing preventive interventions, digital hygiene policies, and institutional regulation to ensure sustainable and healthy academic work environments.
This study highlights the critical impact of digital fatigue on the mental health of academic nurses, emphasizing its potential to impair professional functioning and wellbeing. Recognizing and addressing digital burnout can inform the development of organizational strategies to promote healthier digital practices and a better work-life balance. The findings offer valuable insights for healthcare institutions to support the mental resilience of academic nurses in increasingly digitalized work environments.
Academic nurses shared their experiences and insights, contributing to a deeper understanding of how digital fatigue impacts mental health in healthcare settings.
Turnover intention among nurses poses a significant threat to both workforce stability and the overall quality of healthcare delivery. However, few studies have comprehensively examined the associations between turnover intention and nurses' individual and team-level resources within a multilevel framework. Our study aims to provide an in-depth exploration of the relationship between turnover intention and nurses' individual and team-level resources.
The multicenter cross-sectional study adopted a stratified convenience sampling approach to enroll 773 clinical nurses from 62 teams across eight hospitals in Shandong Province, China.
We used the 10-item Connor-Davidson Resilience Scale for psychological resilience, the Perceived Social Support Scale for perceived social support, the 51-item Analyzing and Developing Adaptability and Performance in Teams to Enhance Resilience Scale for team resilience, and a single-item turnover intention measure. Multilevel logistic regression modeling was conducted to examine the simultaneous impacts of individual-level (psychological resilience and perceived social support) and team-level (team resilience) factors on turnover intention, while controlling for key demographic and organizational covariates.
The multilevel analysis revealed several key findings: (1) The prevalence of turnover intention reached 35.6%, indicating a substantial workforce stability challenge; (2) Multilevel modeling demonstrated significant between-team variance (ICC = 0.19), confirming the importance of examining nested data structures; (3) At the individual level, both psychological resilience (OR = 0.78, CI: 0.62–0.99) and perceived social support (OR = 0.75, CI: 0.60–0.94) showed significant negative associations with turnover intention; (4) At the team level, higher team resilience predicted lower turnover intention (OR = 0.73, CI: 0.56–0.94). These results were obtained after controlling for key demographic and organizational covariates, highlighting the robust protective effects of multilevel resources against nurses' turnover propensity.
The prevalence of turnover intention was relatively high in this study. Nurses with higher psychological resilience, perceived social support, and team resilience exhibited lower turnover intention. Healthcare administrators need to increase investments in nurses' multilevel resources to stabilize the nursing workforce and ensure the sustainability of the healthcare system.
Understanding the multi-level factors influencing nurses' turnover intention can help nursing managers develop targeted strategies from multiple perspectives in clinical settings, thereby reducing nurses' turnover intention.
Women constitute the majority of the global healthcare workforce—especially in nursing—yet remain under-represented in formal leadership roles. Understanding how gender disparities intersect with profession, age, and governance models is critical to advancing equity and strengthening nursing leadership within health systems.
Cross-sectional ecological study across publicly funded healthcare entities in Catalonia, Spain.
Data from 124 entities were collected as of 31 December 2023 and analyzed by gender, profession (physician, nurse, or other), age group (≤ 55, > 55), and governance model (direct vs. indirect management) across five hierarchical leadership levels. Descriptive and inferential analyses were conducted to examine gender disparities in leadership distribution.
A total of 8015 leadership positions were identified, of which 62.2% were held by women, despite women representing 75% of the workforce. A clear gender gradient emerged across leadership levels, with women's representation decreasing systematically at each step upward in the hierarchy. Women's representation declined significantly with increasing seniority, whereas men's representation increased at higher organizational levels. Among professions, male physicians were markedly represented at senior levels, while nurses—both women and men—were concentrated in lower and mid-level positions. Gender disparities were also shaped by age and governance model: younger women were clustered in frontline roles, and female leaders in indirectly managed entities were more evenly distributed across leadership levels than those in directly managed organizations.
Persistent gender disparities—particularly affecting nurses and younger professionals—highlight the need for inclusive leadership development, transparent promotion pathways, and robust gender-disaggregated data for workforce planning. Strengthening nursing leadership is not only a matter of equity but a strategic priority for building inclusive and responsive health systems.
Systematic reviews (SRs) require comprehensive, reproducible searches, yet developing search strategies is resource-intensive and demands specialized expertise. Generative AI offers potential to streamline this process, but empirical evaluations for GAI-assisted SR searching remain scarce. The objectives of this study are to: demonstrate a step-by-step process for developing a custom ChatGPT-based chatbot to support SR search strategy development, and evaluate its performance.
A cross-sectional evaluation study.
We used ChatGPT-4.0 to create a chatbot designed to mimic a medical librarian, generating PICO-informed searches. Its knowledge base was augmented with two methodological references. After piloting testing, we refined its instructions. For evaluation, we randomly sampled 50 Cochrane SRs published in 2024. Standardized P–I–O prompts produced database-ready queries for PUBMED and EMBASE. The primary outcome was per-review success rate, summarized by median and inter-quartile range. A sensitivity analysis was conducted.
Pilot testing achieved a retrieval rate of 41/49 (83.7%). In the main sample (1169 studies; median 13.5 studies per SR), the chatbot identified a median of 67.4% of included studies (IQR: 43.1%–88.4%). When limited to indexed studies (n = 1114), retrieval rose to 72.0% (IQR: 46.0%–92.5%). Lower performance was observed when outcomes were absent from the abstracts or interventions had many lexical variants.
A GAI-based chatbot can rapidly generate SR searches (~67%–72% identification), serving as a useful starting point but not a replacement for expert-led approaches. Integration of librarian expertise, structured prompts, and controlled vocabularies may improve performance. Further benchmarking and transparent reporting are needed to guide adoption.
Whereas diabetes-related stigma is increasingly recognized as a barrier to diabetes management, little is known about this social phenomenon in collectivist African settings. The purpose of this study was to examine diabetes-related stigma among adults with type 2 diabetes (T2D) in Ghana, highlighting behavioral and psychological mechanisms underpinning the impact of stigma on hemoglobin A1C.
Cross-sectional analytical design.
Adults with T2D (n = 190), seeking care at a tertiary hospital in Ghana, were recruited. A battery of questionnaires assessing psychological (diabetes-related stigma, depression, anxiety, diabetes distress) and behavioral constructs (diabetes concealment and diabetes self-management) were administered. Venous blood samples were obtained for A1C assessment. A latent variable, “adverse psychological outcomes” comprising anxiety, depression, and diabetes distress, was derived and validated using confirmatory factor analysis. Structural equation modeling was used to test multiple psychological and behavioral pathways through which stigma was associated with A1C.
Participants had an average age of 59.44 (SD = 10.7) years, were mostly female (70.5%, n = 134), and had T2D diagnosis for a median of 14.5 years. We found significant indirect effects of T2D stigma on HbA1c through adverse psychological outcomes alone (β = 0.16; 95% CI: 0.01, 0.32, p = 0.038), as well as the combination of adverse psychological outcomes and self-management behaviors (β = 0.16; 95% CI: 0.001 to 0.32, p = 0.048). We also found that the association between T2D stigma and diabetes self-management was fully mediated by adverse psychological outcomes, and participants who conceal their diabetes tend to report greater adverse psychological outcomes.
We note that adverse psychological outcomes play a central role in how T2D stigma is associated with HbA1c. Our findings provide preliminary insight into potential aspects of diabetes that may be targeted in future stigma-reduction interventions.
Our results do provide some indication that addressing mental health issues in individuals with T2D may be an effective intervention strategy in curtailing the adverse clinical effects of T2D stigma. Additionally, our results highlight the importance of incorporating mental health care as part of routine diabetes management in Ghana and other similar African countries where mental health issues are often not prioritized by the healthcare system.
Clinical nurses face notable chronic stress due to work-related stressors, exacerbated by the COVID-19 pandemic, leading to somatic symptoms and low-grade inflammation. Mindfulness meditation has shown promise in reducing stress and improving health outcomes, but its effects on somatic symptoms and inflammatory biomarkers in nurses remain underexplored.
To assess the impact of mindfulness meditation on somatic symptoms and inflammatory biomarkers such as leptin, interleukin-6, and tumor necrosis factor-α among nurses. To explore the secondary effects on perceived stress and trait mindfulness because of the complex interlinked association with the primary outcomes of interest.
A randomized controlled trial was conducted with 102 nurses randomly assigned to a meditation group (8-week mindfulness meditation program) or a non-meditation group. Data were collected using self-report questionnaires (Mindfulness Attention Awareness Scale, Perceived Stress Scale, Patient Health Questionnaire-15) and blood samples for biomarker analysis at baseline and post-intervention.
The meditation group demonstrated notable reductions in perceived stress (p < 0.001), somatic symptoms (p < 0.001), IL-6 (p < 0.001), and leptin levels (p < 0.001) compared to the non-meditation group. Trait mindfulness increased markedly in the meditation group (p = 0.003), while TNF-α levels did not show notable changes.
Mindfulness meditation efficiently reduces perceived stress, somatic symptoms, and inflammatory biomarkers in nurses, highlighting its potential as a holistic intervention to improve both psychological and physical well-being in high-stress healthcare environments.
ClinicalTrail.gove, NCT06635278
Falls among older adults represent a major public health challenge, yet research examining the role of social determinants of health (SDOH) in fall risk remains limited. This study aimed to identify factors associated with fall occurrence and fall frequency among community-dwelling older adults in Korea, with particular emphasis on SDOH.
A cross-sectional study design.
We used a large nationwide sample (n = 9746) from the 2023 National Survey of Older Koreans. The number of falls in the past year served as the dependent variable. Independent variables included a range of socioeconomic and environmental variables as SDOH, alongside biological and behavioral variables. A zero-inflated negative binomial (ZINB) regression analysis was employed to address excess zeros and overdispersion in fall count data.
Among participants, 94.8% experienced no falls, 3.2% reported a single fall, and 1.9% reported recurrent falls. In the logit model for fall occurrence, higher household income level, absence of age-friendly housing, higher access to parks, and lower access to welfare centers were associated with higher risk of fall occurrence. In the count model for fall frequency, higher education level, presence of age-friendly housing, and outdoor mobility barriers were associated with higher fall frequency within the at-risk group.
The findings provide empirical evidence on the critical roles of SDOH in falls among community-dwelling older adults. Specifically, a ZINB regression analysis identified distinct sets of SDOH associated with fall occurrence versus fall frequency, highlighting the complex and multifaceted nature of fall patterns among older adults.
Healthcare providers and policymakers seeking to reduce falls should implement tailored, SDOH-integrated strategies by addressing the different mechanisms underlying fall occurrence and fall frequency.
Parents of adolescents with a mental disorder describe having overwhelming feelings regarding the psychiatric diagnosis, which they respond to with grief. Existing research indicates that these parents face unique challenges, such as self-blame and stigma. Parents are crucial in adolescent care, and healthcare professionals should find interventions that educate parents about the disorder, treatment and symptom management. The aim of this study was to explore and describe parents' experiences in having an adolescent with a mental disorder admitted to the psychiatric unit of a public hospital in Gauteng, South Africa.
The study used Heidegger's interpretive phenomenological design.
A qualitative, exploratory, descriptive and contextual method was used. Data were collected through semi-structured telephonic interviews with 10 parents who had an adolescent with a mental disorder admitted to a public hospital in Gauteng, South Africa. Tesch's thematic coding steps were used for data analysis.
The themes arising from the findings reflected (1) parents experienced that their lives were stuck amid grief for the loss of what their adolescent child used to be, and anxiety about what the future holds, (2) parents experienced that when they reached out for professional help, the healthcare system failed them due to a lack of guidance, information and support, (3) parents experienced that they prayed for divine intervention as a coping strategy, and (4) parents experienced stigma from the community.
The findings illustrate the need for psychiatric nurses to facilitate the mental health of parents of adolescents with a mental disorder. Furthermore, positive attitudes among parents are improved once they are empowered and receive the necessary support, and stigmatization will also be reduced. It is recommended that further research be conducted to explore the effectiveness of emotional and professional support in addressing the challenges parents experience with an adolescent who has a mental disorder.
This paper contributes knowledge to nursing practice by exploring the experiences of parents who have an adolescent with a mental disorder in the South African context.
FreshRSS 