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Osteoporosis is a chronic skeletal condition that significantly affects daily life and may benefit from adequate self-care. The Middle-Range Theory of Self-Care of Chronic Illness conceptualizes self-care as a naturalistic process encompassing maintenance, monitoring, and management, also shaped by contextual and cultural factors. Despite this theoretical framework, limited evidence exists on how people with osteoporosis conceptualize and enact self-care in different cultural contexts. Italy and Spain provide comparable yet distinct settings for exploring cultural influences on self-care practices. This study aims to explore and compare self-care behaviors among Italian and Spanish people with osteoporosis.
A cross-national qualitative study was conducted using an Automatic Analysis of Textual Data approach within the Exploratory Multidimensional Data Analysis framework.
Forty people with osteoporosis (38 women and 2 men; mean age 68.6 years, SD = 5.74) were recruited, equally distributed between Italy (n = 20) and Spain (n = 20). Data were analyzed using Labbé's intertextual distance and correspondence analysis to examine lexical similarities, differences, and semantic structures of self-care narratives.
Although moderate intra-national lexical similarity was observed within each national group, substantial inter-national differences emerged between Italian and Spanish participants in the discursive construction of self-care. Italian participants described self-care as a medically mediated and system-oriented process, closely linked to professional guidance, diagnostic procedures, and prescribed treatments. In contrast, Spanish participants framed self-care as embodied, routine-based, and emotionally expressive, grounded in daily practices and bodily awareness. These findings indicate that participants relied on distinct cultural and epistemic models when interpreting and organizing self-care experiences.
This study highlights clear cross-cultural differences in how people with osteoporosis narrate and conceptualize self-care. Methodologically, it illustrates the potential of multidimensional analysis to support systematic and transparent comparison of qualitative datasets. The findings are consistent with the Middle-Range Theory of Self-Care and suggest that greater attention to cultural contexts may inform the development of self-care interventions that are more responsive to individuals' lived experiences.
Recognizing how cultural contexts influence how people with osteoporosis understand and practise self-care may help nurses tailor communication and educational support to individuals' everyday experiences, supporting more responsive and culturally sensitive care.
This narrative review synthesizes published evidence on the applications, benefits, limitations and governance considerations of ChatGPT and large language models (LLMs) in nursing, across three domains: education, clinical practice and workflow management.
The article was conducted as a narrative review.
A structured literature search was conducted in Medline (via PubMed), Scopus and arXiv, covering publications from January 2019 to March 2026. Peer-reviewed original studies, systematic reviews, scoping reviews, narrative reviews and expert commentaries addressing LLM applications in nursing education, clinical practice or workflow were eligible for inclusion. Studies limited exclusively to non-nursing medical specialties without transferable nursing implications were excluded. Findings were narratively synthesized across five thematic domains by authors with subject-matter expertise in each area.
In nursing education, ChatGPT demonstrates utility as an adaptive cognitive scaffold, supporting theoretical learning, simulation-based training and virtual patient encounters, though unregulated use poses risks to academic integrity and independent clinical reasoning. In clinical practice, LLMs can assist with preliminary symptom assessment and patient education material generation; however, performance deteriorates markedly in complex or data-sparse clinical scenarios and hallucination rates remain clinically significant. In workflow management, ChatGPT shows promise in reducing documentation burden and supporting administrative tasks, though data privacy obligations under frameworks such as GDPR constrain real-world deployment. Across all domains, concerns persist regarding algorithmic bias, professional accountability and the absence of clear medico-legal frameworks governing AI-related clinical errors.
ChatGPT and related LLMs are best positioned as auxiliary tools that augment rather than replace professional nursing judgement. Safe and ethical integration requires the development of AI literacy curricula, institutionally governed deployment frameworks, mandatory human-in-the-loop verification protocols and longitudinal evaluation of patient safety outcomes. Nurses must play an active role in shaping the responsible adoption of generative AI in healthcare.
1. Nurses must treat AI-generated content as a preliminary draft requiring mandatory human verification before clinical or documentation use. 2. Institutions should prioritize closed-loop, enterprise-grade AI deployments over public platforms to ensure GDPR compliance. 3. AI literacy must be embedded in undergraduate and continuing nursing education curricula. 4. Longitudinal research on patient safety outcomes following real-world LLM deployment in nursing is urgently needed.
As a narrative review, this article followed established guidance for the conduct and reporting of narrative reviews.
There was no patient or public involvement in this narrative review.
To explore how older adult-family caregiver dyads jointly manage multiple chronic conditions. Specifically, it investigates how dyads (i) prioritise chronic diseases, (ii) make and negotiate decisions related to self-care and (iii) define and distribute self-care tasks and caregiver contributions.
A qualitative descriptive study using dyadic data collection and analysis.
Semi-structured interviews were conducted separately with chronically ill older adults and their family caregivers between July and December 2024. A hybrid inductive-deductive content analysis was applied. Dyadic analysis compared intra-dyad perspectives to identify patterns of agreement and disagreement.
Thirty-four dyads (n = 68 participants) were interviewed. Older adults had a mean age of 80.09 years (SD = 6.95) and were affected by a median of four chronic conditions. Family caregivers had a mean age of 51.71 years (SD = 14.59), with most being the older adults' children (66.67%) and women (82.35%). Five categories, comprising 25 subcategories, were derived from the data. Disease prioritisation varied within dyads: older adults often focused on conditions with the most disabling symptoms, while caregivers emphasised those with higher risks of complication. Decision-making roles ranged from older adult-led to caregiver-led to shared. Care organisation followed three models: collaborative, older adult-directed, or caregiver-directed. Challenges in managing diseases included treatment adherence, care coordination, emotional burden and addressing multiple symptoms simultaneously. Role distribution in disease management and decision-making was complex and occasionally misaligned, sometimes resulting in conflict. Collaborative dyads reported greater adaptability and balance, while incongruent dyads experienced relational and organisational strain.
Managing multiple chronic conditions in older adults is a relational process shaped by interpersonal dynamics and shared responsibilities with family caregivers. Recognising dyadic relational patterns is essential for designing targeted educational interventions. Nurses should incorporate dyadic assessments into routine care to improve outcomes for older adults and reduce caregiver burden.
This study highlights the importance of viewing chronic disease management as a dyadic process, rather than an individual task, involving both the older adult and the family caregiver. Tailored strategies that account for the relational dynamics within dyads, such as decision-making roles and care task distribution, are essential for effective chronic disease management.
Consolidated criteria for reporting qualitative studies (COREQ).
None.
Osteoporosis requires long-term self-care engagement, yet little is known about how individuals experience and manage self-care in everyday life. Understanding these experiences is essential to inform tailored nursing interventions. The objective of the study was to explore and describe the experience of self-care maintenance, monitoring, and management in people with osteoporosis.
A qualitative descriptive study.
We conducted semi-structured interviews. Data were analyzed using Mayring's qualitative content analysis with a deductive approach based on Riegel's theory of self-care. We reported data in accordance with the Consolidated Criteria for Reporting Qualitative Studies (COREQ) checklist.
Participants (1 Male, 19 Females; Aged 55–80) Identified Four Themes of self-care: maintenance (e.g., Medication Adherence, Physical Activity), monitoring (e.g., Symptom Recognition, Test Interpretation), management (e.g., Lifestyle Reflections, Prevention), and general self-care. Key factors included motivation, trust in healthcare professionals, and integration of health behaviors into daily life. Barriers were low self-efficacy, poor symptom recognition, and inconsistent adherence.
Self-care in osteoporosis is a multidimensional and dynamic process influenced by individual beliefs, contextual factors, and support from healthcare professionals. Recognizing the variability in patients' self-care behaviors is essential to develop personalized education and support. Strengthening general health behaviors may enhance disease-specific self-care. This understanding can guide healthcare professionals in designing more effective, tailored care strategies.
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