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To describe the leadership trajectories of graduates of a Doctor of Philosophy in Nursing Education programme in a single university in the Philippines and examine how the doctoral programme influenced these trajectories.
Qualitative design, specifically thematic narrative analysis.
A total of 10 purposively selected graduates of the programme were interviewed with the aid of videoconferencing and life-calendaring methods.
The emerging central narrative theme is transformative potential. Leadership trajectories are characterised by expanding fields of transformative potential from within to beyond their organisations. Doctoral education shapes these trajectories through curriculum-driven capacity building, beyond-curriculum capacity building and character building.
The evolving leadership trajectories of graduates of the Doctor of Philosophy in Nursing Education programme are characterised by expanding and accumulating transformative potential.
The findings can help nursing academic institutions design and improve postgraduate degrees, which will develop transformational leaders in the profession.
What problem did the study address?
This study aims to map and describe the leadership trajectories of graduates of a Doctor of Philosophy in Nursing Education programme.
What were the main findings?
The leadership trajectories of graduates are characterised by expanding and accumulating transformative potential.
Where and on whom will the research have an impact?
The findings can inform the planning, design and evaluation of doctoral nursing degree programmes in higher education institutions, as well as continuing educational programmes for nursing leaders in academic and clinical settings.
Initial findings were sent to the graduates of Doctor of Philosophy in Nursing Education programme to validate the qualitative insights as part of member checking.
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.
To evaluate the effectiveness of simulation-based interprofessional education (IPSE) interventions on teamwork, communication and psychological safety outcomes among healthcare professionals and students.
A systematic review.
Searches were conducted across PubMed, CINAHL, Scopus, Web of Science and Cochrane CENTRAL, supplemented by manual reference and citation tracking.
The search strategy was developed with an academic librarian to ensure thoroughness and relevance. The review included randomised controlled trials (RCTs) and quasi-experimental studies published between 2010 and 2025. Eligible studies reported quantitative outcomes of IPSE interventions involving at least two healthcare professions. Risk of bias was assessed using RoB 2 for RCTs and ROBINS-I for quasi-experimental studies.
Thirty studies (14 RCTs, 16 quasi-experimental) from 16 countries were included. Most studies reported positive effects on teamwork, including improved coordination, role clarity and adherence to structured protocols. Communication outcomes showed enhanced information exchange, clarity and structured behaviours, such as SBAR and closed-loop communication, although some studies noted inconsistent safety practices. Psychological safety outcomes demonstrated gains in self-confidence, self-efficacy, leadership and safety climate, with several studies also reporting reduced anxiety. However, findings on stress, workload and attitudinal change were mixed. Overall, RCTs were judged methodologically robust, and quasi-experimental studies were largely low risk with some moderate concerns.
Simulation-based interprofessional training enhances teamwork, communication and psychological safety in fostering a healthy work environment, though effects vary by context and population.
This review synthesises evidence from 30 trials, offering guidance for educators and policymakers on advancing interprofessional collaboration. Integrating IPSE into health curricula and clinical training can strengthen collaboration and contribute to safer patient care.
No patient or public contribution.
The review adhered to PRISMA 2020 guidelines, and the protocol was registered in the PROSPERO international prospective register of systematic reviews (ID: CRD420251039410).
To explore the impact of Doctor of Nursing Practice (DNP) education on career advancement, job satisfaction, leadership competencies and contributions to healthcare systems.
The study utilised a scoping review methodology based on Arksey and O'Malley's (2005) framework.
The search strategy was developed with an academic librarian to ensure thoroughness and relevance. Seven databases were searched using MesH terms. Inclusion criteria focused on peer-reviewed studies examining DNP education's influence on career advancement, job satisfaction and leadership. Thematic analysis was used to identify patterns and themes.
Studies were selected based on their focus on DNP-prepared nurses, nursing faculty or advanced practice nursing students in healthcare or academic settings, published between 2004 and 2024.
Twenty-one studies met the inclusion criteria, highlighting DNP education's role in fostering leadership, professional development and evidence-based practice. Thematic analysis revealed the benefits of being a DNP graduate include contribution to professional development, contribution to leadership and contribution to the practice environment. The challenges to DNP graduates include underrecognition of competencies, high educational costs and limited academic opportunities that were also identified.
DNP education contributes to individual and professional growth, leadership development and healthcare system improvements. However, barriers such as financial constraints and inadequate recognition of DNP competencies must be addressed to maximise the impact of this educational model.
DNP education empowers nurses to lead healthcare innovations, enhance patient care quality and reduce disparities in health outcomes. Strengthening financial and systemic support for DNP graduates is essential for sustaining these contributions.
DNP education is a transformative force in nursing, offering significant opportunities for leadership development and healthcare advancements. Aligning DNP programmes with evolving global healthcare challenges can further strengthen their impact on the profession and patient care.
PRISMA-ScR guidelines were followed.
by Andrea Valdivia-Gago, Patricia J. García, Sherilee L. Harper, Angela Soria, Carol Zavaleta-Cortijo
Peru issued multiple COVID-19 policies for the Amazon, yet how they worked in practice for Indigenous Peoples remains under-documented. We conducted a sequential multi-method qualitative study, reviewing 20 national and regional policy documents (Mar–Dec 2020) and interviewing 12 implementers, regional and local officials from the health sector (n = 8) and the Ministry of Culture (n = 4), plus one central-level culture representative, in Loreto and Junin. Triangulating top-down policy review with bottom-up practitioner accounts across two contrasting regions strengthened validity. Policies frequently lacked explicit intercultural guidance, clear monitoring indicators, and dedicated budgets. Implementers described budget misalignment, omission of specific health networks, delayed supplies, and connectivity barriers that fostered dissatisfaction and a perception that services prioritized data collection over care. Effects were most acute in remote and low-connectivity settings; Indigenous federations’ participation in Loreto sometimes mitigated challenges, while in Junin travel-fund constraints limited participation. Pandemic preparedness must institutionalize intercultural approaches and secure sustainable funding with clear accountability. Co-design with Indigenous organizations, ring-fenced implementation budgets, practical communication strategies, and routine monitoring are essential to protect Indigenous Peoples in future health emergencies.To assess the magnitude and associated factors of suicidal behaviour and non-suicidal self-injury (NSSI) among youth of the Gurage Zone, Southern Nations, Nationalities, and Peoples Regional, Ethiopia, 2024.
A community-based cross-sectional study was conducted.
This research was carried out in the Gurage Zone.
This study was conducted among 719 Gurage Zone youths from 1 January 2024 to 1 February 2024.
Suicidal behaviours and non-suicidal self-injury were assessed using a pretested, interviewer-administered, structured questionnaire. Data were entered in EpiData V,3.1 and exported to SPSS V.25 for analysis. A binary logistic regression model was used to identify significant factors associated with suicidal behaviours and NSSI. Variables with a p-value less than 0.05 and adjusted ORs with 95% CI were used to declare association with the outcome variable in the final model.
Out of the total 820 study participants, 719 participants participated in the study, giving a response rate of 88%. Among 719 respondents 465 (64.7%) were males. The prevalence of high risk of suicidal behaviours was 11.7% (95% CI 8.14 to 14.30) and it is significantly associated with substance use in the last 3 months (adjusted OR (AOR)=6.84; 95% CI 3.48 to 13.47), having moderate insomnia (AOR=3.09; 95% CI 1.30 to 7.31) and having depression (AOR=6.84; 95% CI 3.48 to 13.47).
The prevalence of NSSI among youths was 38% (95% CI 34.52 to 41.86). Substance use in the last 3 months (AOR=2.459; 95% CI 1.59 to 3.81), youths having depression (AOR=3.348; 95% CI 2.29 to 4.91), youths who were exposed to stressful life events (AOR=9.86; 95% CI 6.46 to 15.07) were significantly associated with NSSI.
Nearly 1 in 10 youths in the Gurage Zone exhibited high-risk suicidal behaviour, and over one-third reported NSSI. Suicidal behaviour was significantly associated with substance use, depression and moderate insomnia, while NSSI was significantly associated with substance use, depression and exposure to stressful life events. These findings highlight the prevalence of self-harm and the key factors associated with these behaviours among youth in this region.
by Abate Atimut Dereje, Dereje Geleta, Tadesse Menjetta, Abinet Takele, Susana Vaz Nery, Techalew Shimelis
BackgroundEarly diagnosis and prompt treatment of malaria cases are a crucial component of curative and preventive interventions. There have been reports of healthcare workers overprescribing antimalarial agents against guidelines, but the barriers they face in adhering to the guidelines are not well studied. This study aimed to investigate barriers to adherence to guidelines in prescribing antimalarial drugs in public healthcare facilities in Arba Minch, South Ethiopia.
MethodA cross-sectional descriptive exploratory qualitative method was employed. We included ten participants from public healthcare facilities, including health centres, a hospital, a city health office, and a zonal health bureau. A key informant interview technique was used to collect data. All interviews were audio-recorded, transcribed, and analyzed. Data analysis was performed using ATLAS.ti, version 7.5 software. The results were presented thematically and narrated to support the main themes.
ResultsPublic healthcare facilities primarily used blood smear microscopy to test all malaria-suspected patients. However, in cases of microscopy service interruptions or when confirming negative results, rapid diagnostic tests (RDTs) were employed in some facilities. Limited availability of microscopes and reagents, and electric power interruptions hindered reliable microscopy services. Drug stock-outs, patient expectations for antimalarial drugs, self-treatment, and delayed care-seeking are barriers to adherence to malaria treatment guidelines. The main reason for non-adherence to withholding antimalarial drugs after negative tests was greater trust in clinical findings over laboratory results. Confidence in experience contributed to trust in clinical judgment, while perceived inexperience and negligence, inconsistent RDT and microscopy results, and poor-quality control assessment results undermined trust in laboratories. Despite supporting the guidelines, study participants emphasized the need for flexibility to allow empirical treatment and highlighted the lack of training and mentoring for healthcare workers.
ConclusionTo improve adherence to malaria treatment guidelines, it is essential to ensure consistent lab operations, enhance quality assurance, maintain effective communication between lab personnel and prescribers, and provide healthcare and patient education. Implementing training and mentoring programs and promoting evidence-based practices are also crucial.
To assess family caregiver burden and associated factors among caregivers of people with mental illness in Eastern Ethiopia.
Cross-sectional study.
Three hospitals in Eastern Ethiopia.
A total of 422 family caregivers of people with mental illness were recruited using systematic random sampling, of whom 417 participated (response rate 98.8%).
Caregiver burden was assessed using the Zarit Burden Interview (ZBI-22). Linear regression was used to measure the associations between dependent and independent variables.
The mean score of the ZBI was 47.971 (SD=14.539). In our study, factors associated with caregiver burden included age of caregivers (β=0.143, p=0.006), sex of the caregiver (β=0.121, p=0.007), time spent in providing care (β=0.194, p=0.006), presence of comorbid medical illness (β=0.309, p0.001), substance use in the last 12 months (β=0.265, p=0.024), perceived stigma (β=0.207, p
89 (22.2%) of caregivers reported severe burden and 220 (52.8%) reported moderate-to-severe burden. Family caregivers play a critical role in the treatment of mental illness; there is a need to establish family caregiver support services, such as group therapy and psychoeducation.
To further elucidate the effects of rare systemic autoimmune rheumatic diseases (SARD) and their treatment on antibody development after vaccination against SARS-CoV-2, we compared patients with and without immunosuppressive therapy to healthy controls in an observational cohort study.
We enrolled 52 patients with SARD and 72 healthy subjects in a prospective, observational study at the Medical University of Vienna and measured the humoral response 6 months after two mRNA vaccinations and 2–6 weeks after a third dose.
Patients with vasculitis showed significantly (p=0.02) lower antibody titres 6 months after vaccination (median 247 BAU/mL, IQR [185–437]), as compared with healthy controls (median 514 BAU/mL, [185–437], IQR 323; 928, vasculitis patients: 247, IQR [185; 437], p
Patients with SARD displayed lower antibody development after booster vaccination, even if antibody levels after two immunisations were comparable to healthy controls. Our data may be limited due to sample size, but it provides pointers for a more individualised, antibody-titre-oriented approach and earlier booster vaccination in patients with SARD.
El auge de las terapias complementarias y las diversas y contradictorias manifestaciones con respecto a sus efectos justifican la necesidad de evaluar su efectividad para así regular la seguridad de su utilización. Para la valoración crítica del artículo se ha utilizado la herramienta propuesta por el “National Heart, Lung, and Blood Institute” para estudios experimentales prepost sin grupo control. [fragmento del texto]
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