To explore peer volunteers' experiences of delivering online support through SMART to at-risk mothers during the perinatal period, to inform future improvements to mobile-health-application (mHealth app) based peer-support interventions.
Descriptive qualitative research.
The study was conducted between February 2024 and June 2025 in a tertiary public healthcare institution in Singapore. Twenty peer volunteers were recruited via convenience and snowball sampling and participated in individual semi-structured interviews. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis.
Four themes were identified: (a) Giving and receiving: the inner world of peer volunteers; (b) Navigating relational complexity in digital peer support; (c) Facilitating connection and continuity in digital peer support; and (d) Building better connections through supportive ecosystems.
Peers reported experiencing reciprocal benefits, such as a sense of fulfilment and achievement, while supporting mothers. Shared experiences and psychosocial vulnerabilities enhanced relatability, reassurance and rapport, which sustained supportive relationships. Challenges encountered by peers highlighted the need for strengthening both intervention design and peer training.
Regular check-ins by programme facilitators, alongside clear information, flexible guidelines and reassurance, can improve peer volunteers' motivation and resilience, thereby ensuring consistent and sustainable support for at-risk mothers.
Examined peer volunteers' experiences in providing online perinatal support to mothers with diverse psychosocial vulnerabilities. Peers offered emotional, informational and practical support, while mothers benefited from learning how peers had coped with their psychosocial vulnerabilities. Shared experiences fostered confidence and reassurance among mothers that they, too could overcome similar adversities. Valuable in providing both medically accurate perinatal information and meaningful social support to perinatal mothers.
The reporting of the study adheres to the standards outlined in the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.
Mothers and peer volunteers contributed valuable insights and suggestions that helped in the design of the intervention.
The purpose of this concept analysis is to clarify the meaning of digital health equity beyond a simplistic definition, obtaining a richer meaning that can guide the digital healthcare landscape.
With the growing spread of digital health, digital health equity should be at the center of healthcare. Health outcomes for equity-deserving groups may be compromised without a clear understanding of digital health equity. Although the concept of ‘health equity’ has been analysed before; no concept analysis has been completed for the concept of ‘digital health equity’.
Concept analysis using Walker and Avant's method.
Articles from PubMed, Scopus and Google Scholar with no limitation on the period of data collection.
Walker and Avant's concept analysis method was used to outline attributes, antecedents, consequences, and empirical referents of the concept digital health equity.
The main attribute of digital health equity is digital health technology that benefits everyone fairly. The antecedents include: (1) appropriate infrastructure; (2) cognitive abilities including digital literacy; (3) intersectionality of multiple vulnerabilities; (4) presence of the core ethical principles in healthcare; (5) digital accessibility with careful consideration of the social determinants of health; and (6) co-creation of digital health technologies. The main consequences are improved patient health outcomes and elimination of the digital divide.
This analysis explored the concept of digital health equity as a means to promote positive health outcomes for equity-deserving groups, highlighting the critical role of nursing practice and research in addressing digital health disparities.
This paper can have an impact on nursing practice, education and wider social and economic issues. First, various barriers encountered by patients when utilising digital health technologies can be understood. Second, clinicians can be encouraged to assess digital health equity, improve interventions for equity-deserving groups, and evaluate the effectiveness of digital health interventions to ensure they are equitable. In the context of educational implications, the understanding of digital health equity can be used to facilitate the creation of appropriate education materials for clinicians. Finally, on a wider social and economic scale, understanding digital health equity can aid in the creation of policies to enable equitable digital health technologies.
No patient or public contribution because this paper is a concept analysis.
To explore the optimal timing of patient-reported outcome assessment, defined as the collection and use of patient-reported outcomes at clinically meaningful points such as before or during encounters, treatment initiation and follow-up, and to identify the facilitators and barriers to timely use.
A qualitative analysis of semi-structured interviews with healthcare professionals across diverse US health systems.
Thematic analysis was used to identify key themes related to the timing and implementation of patient-reported outcomes assessments. Interviews were analysed iteratively to develop a coding framework and synthesise overarching themes.
Fourteen healthcare professionals, including nurse practitioners, cardiologists and health informatics experts across seven U.S. health systems from academic and community hospitals, were interviewed in February 2024. Three major themes emerged: (1) value proposition of timely patient-reported outcome data collection (2) key facilitators for timely implementation and (3) multilevel barriers. The value proposition focused on the use of patient-reported outcomes for prevention and active disease management. Critical facilitators for the timely implementation of patient-reported outcomes included the involvement of research and clinical coordinators, strategies for pre-visit and on-site patient-reported outcome collection, the use of standardised templates within EHRs and the alignment of patient-reported outcome collection with patients' long-term treatment goals. Finally, multilevel barriers included time constraints, patient-level challenges (e.g., fatigue, literacy, language) and systemic issues (e.g., technical limitations, lack of reimbursement and unclear guidelines).
Timely collection and use of patient-reported outcomes is critical for improving symptom monitoring and supporting patient-centered clinical decision-making. However, multilevel barriers hinder consistent implementation across health care settings.
Integrating patient-reported outcomes into clinical workflows can improve the patient-centeredness of patient-healthcare professional interactions, and provide a more holistic picture of a patient's health status. Addressing barriers to patient-reported outcome implementation, including lack of time, poor health literacy and workflow integration barriers, is crucial for improving clinical outcomes.
This study adhered to the COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist, in accordance with EQUATOR Network guidelines.
No patient or public involvement: This study did not include patient or public involvement in its design, conduct or reporting.
Use a socio-technical strategy to identify the use and implications of generative artificial intelligence (GenAI) tools on nursing education and practice.
Descriptive qualitative study.
Online interviews with 32 nursing students, faculty and practitioners between February and April 2024. Data were analysed using the Framework Method.
Theme 1 described participants' use of eight GenAI tools across seven use cases. Theme 2 describes the implications of using GenAI tools on nursing education. The subthemes include (2.1) facing a new pedagogical reality, (2.2) negative sentiments on using GenAI tools in nursing education and (2.3) opportunities to improve nursing education with GenAI tools. Theme 3 describes the implications of using GenAI tools on nursing practice. Subthemes include (3.1) embedding in patient care, (3.2) nursing workflow integration and (3.3) organisational support. Theme 4 describes GenAI capacity-building. Subthemes include (4.1) to develop an AI-ready workforce, (4.2) to promote responsible and ethical use and (4.3) to advance the nursing profession.
Although GenAI tools initially disrupted nursing education, it is only a matter of time before they disrupt nursing practice. Nurses across education and practice settings should be trained in the responsible and ethical use of GenAI tools to mitigate risks and maximise benefits.
GenAI tools will profoundly impact how nurses of today and tomorrow learn and practice the profession. It is crucial for nurses to actively participate in shaping this technology to minimise risks and maximise benefits to the nursing profession and patient care.
This study revealed the socio-technical intricacies of using GenAI tools in nursing education and practice. We also present wicked problems that nurses will face when using GenAI tools.
COREQ.
This study did not include patient or public involvement in its design, conduct or reporting.
To explore the competency of nursing graduates from the four dimensions of clinical practice, research ability, teaching ability and management ability, analyse its influencing factors and provide data support for improving the post ability of nurses with a master's degree.
In September 2024, a convenience sampling method was used to administer a self-designed questionnaire regarding post-graduation post-competency to 330 nursing master's degree graduates from 68 tertiary hospitals and five medical universities across China.
The average scores of clinical competence, research competence, teaching competence and management competence of nursing graduates were more than 7 (out of 10 points). Based on the Benner model, all the abilities of the participants were at the level of competent. Multivariate linear regression analysis indicated that marital status (p < 0.001), years since graduation (p < 0.001), major (p < 0.001) and et al., significantly influenced clinical competency. Furthermore, marital status, major, hospital rank and graduate type were key research competency factors. For teaching competency, major, training nature and professional title played a crucial role, whereas major, professional title, marital status and hospital rank were essential for management competency. Multivariate logistic regression analysis indicated that job position (χ 2 = 11.375, p = 0.01) significantly influenced SCI publication, whereas the training nature and type of graduate school were independent factors affecting publication in Chinese core journals. Moreover, years since graduation and professional title were independent factors that influenced the publication of scientific core journals.
The post-competency scores of nursing master's degree graduates in the four dimensions of clinical, research, teaching and management were moderate, indicating substantial potential for enhancement. Managers should develop personalised training programs based on different factors that influence the overall competency of nursing master's degree graduates, thereby improving nursing quality and ensuring patient safety.
To identify the competencies required for hospital-based WOC nurses to provide direct pressure injury (PI) care in home care settings in Japan.
Mixed methods convergent design.
The qualitative strand used a descriptive design to explore competencies for overcoming barriers faced by hospital-based WOC nurses when providing PI care at home. The quantitative strand used a cross-sectional design to assess competencies in organising the hospital PI management system.
Six competencies were identified: (1) Establish relationships with home healthcare professionals; (2) Promote hospital-based WOC nurse's expertise to home healthcare professionals; (3) Collaborate with the regional medical liaison office in WOC nurse's hospital; (4) Involve hospital administrators in home PI management; (5) Utilise social media/Information and Communication Technology for patient or home-visiting nurse communication; and (6) Utilise public or academic support projects to facilitate home-based activities. The median scoring rate for each medical staff domain on the revised Collaboration Competency Scale for WOC Nurses ranged from 80% to 91%.
The results of this study can serve as a practical resource to help WOC nurses expand their activities into home-care settings.
Their ability to coordinate with staff and manage PI care within hospitals supports active engagement in home care, improving continuity and quality.
This study addressed the issue that many hospital-based WOC nurses cannot visit patients at home. The competencies identified may enable these nurses to expand their role into home care.
This study followed EQUATOR guidelines, with the STROBE Statement applied to the quantitative part and the COREQ checklist to the qualitative part.
Patients or the public were not involved in the study's design, conduct, or reporting.
Limited literature has focused on people with cancers' preference for care providers in scenarios where trade-offs may have to be made.
To report the results of a comprehensive search and synthesis of discrete choice experiments or best-worst scaling studies (± willingness to pay estimates) in scenarios involving cancer nurses, with a focus on: (1) preferred care provider; and (2) relative importance of attributes of care provision for people with cancer.
A search was conducted across: CINAHL, Cochrane Central Register of Controlled Trials, EconLit, Medline, PsycINFO, Scopus, Web of Science Core Collection, and Google Scholar for discrete choice experiments published between January and July 2025. Data were extracted and appraised by two authors. Results were narratively synthesised.
Of 461 studies screened, 11 were included, published in Australia (n = 3), UK (n = 3), and China (n = 5) including people with breast (n = 4), gastric (n = 4), prostate (n = 1), or mixed cancers (n = 2). In six studies exploring scenarios of follow-up care (i.e., survivorship/surveillance), cancer medical specialists were the preferred care provider, followed by cancer nurses, and then general practitioners. In four of the five studies of supportive care scenarios (i.e., diet and exercise advice, anxiety and depression screening), cancer nurses were the preferred care provider, followed by allied health professionals, then cancer medical specialists. The highest WTP estimate was $US226.15 for a medical specialist to provide follow-up care. For supportive care, the highest WTP was $US137.52 for a cancer nurse to provide diet-based lifestyle advice post-treatment for breast cancer.
Cancer nurses are highly valued by people with cancer, particularly for supportive care provision. Opportunities exist for an increase in cancer nurse specialists with expanded scope of practice, to support the preference of people with cancer to have cancer medical specialists, or cancer nurse specialists provide expert cancer follow-up care.
Employees of a cancer patient advocacy group were involved in the design of the study, interpretation of the data, and the preparation of the manuscript. No patients were involved in this work. However, this systematic review prioritized patient voices by including studies that reported on the preferences of people with cancer.
To describe nurses' self-perceived confidence in patient safety competencies and examine how work- and education-related factors influence this confidence.
A descriptive, explorative, cross-sectional survey design.
The Health Professional Education in Patient Safety Survey (H-PEPSS) was administered to a convenience sample of practising nurses and master's degree students in Estonia between May and September 2023. The following background variables were included: work experience, workplace, educational level and prior patient safety training. A total of 376 respondents completed the survey. Data were analysed using descriptive statistics and multivariable logistic regression, which returned the odds ratios for associations between background factors and confidence in patient safety.
Nurses perceived the highest confidence in understanding human and environmental factors, and the lowest confidence in teamwork. Having longer work experience was found to demonstrate a positive association with nurses' confidence in teamwork (OR = 1.03, 95% CI = 1.01–1.05) and safety culture (OR = 1.02, 95% CI = 1.00–1.04), compared to nurses with less experience. Nurses in smaller hospitals felt more confident managing safety risks (OR = 2.19, 95% CI = 1.14–4.21), compared to nurses from bigger hospitals. Master's degree students showed significantly higher confidence in responding to adverse events and safety culture than other respondents. Prior patient safety training was associated with greater confidence across several domains.
Confidence in patient safety competencies varies by domain and was found to be noticeably shaped by experience, education and workplace context. As such, targeted training and supportive environments are essential to ensuring high levels of competence among nursing professionals.
The findings underscore how improvements in training and organisational support can strengthen patient safety. Furthermore, retaining experienced and diversely educated nurses is key to building confidence and ensuring a competent workforce. The finding that respondents assess their confidence in teamwork as weak means that new educational interventions need to be designed and implemented to target this aspect of nursing care.
This study followed the STROBE guidelines for cross-sectional research.
No patient or public contribution.
Nurses are pivotal in EBHC implementation; however, its adoption remains limited, highlighting the need to investigate nurses' experiences and perceptions of their EBHC competence.
To critically appraise and synthesise qualitative evidence of nurses' experiences and perceptions of EBHC competence.
A qualitative systematic review.
The review followed the JBI methodology for qualitative systematic reviews. Inclusion criteria were qualitative studies published in Finnish, Swedish or English that explored nurses' experiences and perceptions of EBHC competence. Data were synthesised using JBI's meta-aggregation method and the findings were graded with the ConQual approach.
CINAHL, Medic, PubMed, Scopus and grey literature from EBSCO Open Dissertations and MedNar, searched in December 2023.
Seventeen qualitative studies were included. The study findings were generated from four synthesised findings with low confidence scores. The synthesised findings were: (1) Nurses' competence in Global Health, (2) Nurses' competence in enhancing Evidence generation, (3) Nurses' competence in optimising Evidence Transfer and (4) Nurses' competence in effective implementation of evidence. A new finding of this systematic review was that nurses did not express their experiences or perceptions on evidence synthesis.
Nurses' experiences of EBHC competence focus mainly on evidence implementation and global health. The lack of findings to evidence synthesis suggests that core principles of the EBHC model are not yet fully embedded in nursing practice. Nurses emphasised the need for greater support for developing EBHC competence.
Integration of EBHC into education, mentoring and adequate resources enhances nurses' competence, motivation and commitment to EBHC sub-dimensions, while also strengthening their professional confidence and development.
Strengthening nurses' EBHC competencies contributes to supporting the delivery of high-quality, effective and sustainable healthcare services.
PRISMA guidelines followed.
None.
PROSPERO-registered: CRD42021285179
There is an increased focus on healthcare workers' bullying due to various individual, organisational, and social factors that may elevate the risk of bullying among healthcare employees. This scoping review aims to identify knowledge gaps regarding the theorising of bullying and the prevention and management of bullying in healthcare settings.
A scoping review of systematic reviews and meta-analyses was conducted using PRISMA guidelines.
Systematic reviews and meta-analyses (N = 18) involving healthcare workers (i.e., doctors, nurses, and allied health professionals) were identified through a vigorous search of ProQuest Central, PubMed, PubMed Central, Google Scholar, Scopus, PsycINFO (PsycNet), and Web of Science databases.
The included reviews were explored to identify theoretical explanations of bullying and strategies for bullying prevention and management. Thematic analysis was applied to synthesise findings.
The results indicated that workplace culture, hierarchy within healthcare organisations, inactive institutional power, and conflict are key theoretical constructs that may explain bullying among healthcare workers. Further, a comprehensive approach of individual and organisational-level factors, involving organisational policies and procedures, creating awareness to promote effective reporting of bullying, and the role of leaders and managers, was identified as critical for preventing and managing bullying.
The scoping review emphasises the need for integrating theoretical frameworks that consider both individual and systemic aspects of bullying in healthcare organisations. Addressing these aspects can improve the effectiveness of strategies for bullying prevention and management.
Understanding the theoretical approaches to explain bullying of healthcare employees can provide a concrete foundation for targeted interventions and organisational policies that address bullying at multiple levels, therefore improving healthcare workers' wellbeing and workplace culture.
No direct patient or public contribution was related to the scoping review.
This study examined cultural, contextual and psychological risk and protective factors for suicide risk (i.e., suicide ideation, planning and attempting in the past year) in a cross-sectional sample of nursing students in the United States.
A cross-sectional study design was employed.
Nursing students (n = 9871) were selected from the national 2020–2021 Healthy Minds Study (HMS). Students reported their demographics, suicidality and non-suicidal self-injurious behaviour (NSSIB). They also completed validated self-report measures of depression, belonging and flourishing.
Logistic regressions revealed that racial minority nursing students were at risk for suicidal ideation and attempts, and sexual minority students were at risk for suicidal ideation. Nursing students with a history of mental illness severe enough to seek treatment and those who reported more NSSIB also evidenced greater odds of reporting all forms of suicide risk. Specifically, the odds of suicidal ideation and attempts were more than three times greater for nursing students who reported NSSIB. Additionally, positive elements of flourishing only marginally protected against suicidal ideation, and belonging was not associated with any form of suicide risk.
Findings highlight the high number of nursing students at risk for suicidality and highlight potential demographic and psychological targets for suicide interventions. Impact: Early intervention during nursing school could impact suicide risk throughout a nurse's educational and professional journey. Thus, nurse educators should consider implementing suicide and mental health interventions in their programmes.
No direct patient or public contribution.
The main purpose of this hypothesis-driven study was to assess levels of change fatigue, adaptive performance and organisational support among ICU nurses; to explore the effects of change fatigue and organisational support on adaptive performance; and to examine the mediating role of organisational support in the relationship between change fatigue and adaptive performance.
A multi-site, cross-sectional survey.
From February to April 2025, 621 ICU nurses from 12 public secondary and tertiary hospitals in Guizhou, Zhejiang, Anhui and Hebei Provinces were recruited via convenience sampling. A questionnaire assessed their change fatigue, perceived organisational support and adaptive performance.
The surveyed ICU nurses in this study exhibited moderate change fatigue, adaptive performance and perceived organisational support. Change fatigue was negatively correlated with both adaptive performance and perceived organisational support (both p < 0.05), while adaptive performance was positively correlated with perceived organisational support (p < 0.05). Perceived organisational support mediated between change fatigue and adaptive performance, accounting for 29.17% of the total effect.
The level of change fatigue can directly affect adaptive performance and influence it indirectly through the mediating role of organisational support. Managers should establish a multidimensional organisational support system to enhance the adaptive performance of ICU nurses.
The findings of this cross-sectional study suggest administrators provide both instrumental and emotional support to ICU nurses to mitigate change fatigue, and recommend implementing resource depletion alert systems and adopting targeted interventions.
No patient or public contribution. This study did not involve patients, service users, caregivers or members of the public.
To synthesize existing qualitative research on the life experiences and needs of patients with malignant fungating wounds, and to provide a theoretical foundation for developing patient-centred wound care plans.
A systematic review of qualitative studies.
A systematic search of PubMed, Web of Science, Cochrane Library, Embase, CINAHL, PsycINFO, CNKI, WanFang, and VIP was conducted to identify relevant studies from database inception to August 2024.
This review adhered to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines.
A total of 12 qualitative studies were included. Five major themes were identified: physiological limitations, psychological alterations, social challenges, disease management needs, and support and care needs.
Patients with malignant fungating wounds face multidimensional challenges that profoundly compromise their quality of life. Comprehensive care for patients with malignant fungating wounds should be delivered through multidisciplinary collaboration, encompassing symptom management, psychological support, health education, and financial assistance.
This study synthesizes qualitative evidence on the complex experiences and needs of patients with malignant fungating wounds, highlighting the profound physical, psychological, and social challenges they encounter. The findings provide valuable insights to support oncology and wound care professionals in designing personalized, patient-centred care strategies.
PROSPERO CRD42024578946
To examine the representation of nurses in Croatian graduate nursing programs and to explore its implications for academic equity, professional development, and nursing leadership.
Cross-sectional descriptive study using document analysis.
Data on lecturers and course leaders for the 2022/2023 academic year were retrieved from all graduate and specialist nursing programs in Croatia. A total of 694 lecturers and 545 course leaders were analysed by professional background.
Nurses accounted for 19% of lecturers in university graduate programs and 14% in specialist studies. As course leaders, they represented 11% in specialist studies and only 4% in university graduate programs. Thirty courses lacked assigned lecturers. The findings demonstrate a strong dominance of medicine and other professions in teaching roles.
Nurses remain markedly underrepresented in academic positions, which may limit their ability to shape curricula, influence educational standards and strengthen professional identity.
Improving the academic presence of nurses could be important for advancing leadership capacity, curriculum relevance and professional equity. Stronger representation may help enhance the profession's authority and indirectly benefit patient care.
What problem did the study address?: The study explored limited nurse representation in graduate nursing education and its implications for equity and autonomy. What were the main findings?: Nurses are a small minority in lecturer and course leader roles, with most positions occupied by non-nursing professionals. Where and on whom will the research have an impact?: The findings are relevant to educators, regulators and policymakers in Croatia and internationally, particularly in countries where nurses face barriers to academic participation. The study supports ongoing policy efforts to strenghten nurses' academic representation and leadership in higher education.
No patient or public contribution. This study relied exclusively on publicly available academic data and did not involve patients, service users or members of the public.
Examine the meaning of ‘successful feeding’ for parents of infants at risk for feeding difficulties and how this meaning evolved from 1 to 24 months post-term age.
Secondary analysis of responses to an open-ended question from a U.S. longitudinal mixed methods study.
At 1-, 6-, 12-, 18-, and 24-months post-term, parents completed surveys which included the question: What is ‘successful feeding’ to you? Using conventional content analysis, 864 responses from parents of 254 infants were coded into the following categories: Child Behaviour, Positive Response, Intake, and Time. Themes characterizing each category were identified.
Child Behaviour, Positive Response, and Intake were common at all time points. Responses related to Time (e.g., eating in a timely manner) were least frequent at 1, 6, and 12 months and were no longer mentioned thereafter. Demonstrating feeding skill/ability and satiety were common themes at all time points. Adequate quantity of food and no adverse response (e.g., emesis, choking) were common themes at 1 month; both decreased thereafter. The perception that the child was engaged in eating and eating nutritionally adequate food increased as children aged.
Parents' perspectives of successful feeding focused on indicators of their child's development and emotional and physical well-being. As their children aged, ate increasingly complex foods, and developed physiologic stability, the meaning of success focused less on the amount of intake and avoidance of an adverse response and more on child well-being.
Nurses and feeding specialists can incorporate parents' views of success as they provide feeding support.
Children having a positive behavioural and affective response to eating, and adequate intake provide evidence to parents of their success in achieving feeding goals. Understanding issues of importance to parents is an essential component of family-centered care of children with feeding difficulties.
No Patient or Public Contribution.
The authors have adhered to the Standards for reporting qualitative research.
To examine how gender differences in the nursing work environment shape nurses' perceived quality of care and to identify gender-specific predictors and evaluative mechanisms.
A mixed-methods design was employed, integrating quantitative data analysis with qualitative in-depth individual interviews.
This study was conducted in two phases: The first phase was a quantitative analysis, based on a large national dataset from the 2017 Chinese Nursing Work Environment Survey (N = 16,382), in which secondary analysis was performed using hierarchical linear regression, relative importance analysis, and network analysis to identify key predictors. The second phase was a qualitative study, in which in-depth individual interviews were conducted with 30 clinical nurses (15 male and 15 female), and thematic analysis was applied to explore gender-differentiated experiences.
The core finding of this study is that gender-differentiated factors within the work environment significantly shape nurses' perception of care quality. Quantitative results showed that the strongest predictor for female nurses was professional development, whereas recognition of value was most salient for male nurses. Qualitative results corroborated these findings: female nurses emphasised continuing education and emotional support, while male nurses emphasised fair evaluation and professional identity. Both groups reported that high-intensity workloads hindered the delivery of ideal humanistic care, inducing moral distress and emotional suppression and exposing ethical gaps in organisational support.
Gender differences in the nursing work environment shape pathways to perceived care quality and expose deeper managerial and ethical challenges. A gender-sensitive, ethics-oriented management approach can enhance nurse satisfaction and care quality, providing empirical support for optimising workforce allocation and sustaining healthcare systems.
Findings direct nurse leaders to tailor improvement strategies—enhancing professional-development infrastructure for women and strengthening recognition mechanisms for men—while embedding explicit ethical support to reduce moral distress and improve both workforce well-being and patient outcomes.
No patient or public contribution.