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Exploring the potential relationships among moral distress (MD), general health (GH) levels, secondary traumatic stress (STS) and levels of empathy within nursing personnel is of specific interest.
This study aimed to investigate the occurrence of MD and its associations with GH, STS, and empathy levels among nurses employed in eight public hospitals across the Attica Basin in Greece.
Between January and March 2020, a cross-sectional study was conducted among nursing staff working in surgical, medical, and psychiatric units of 6 public hospitals and 2 psychiatric institutions in the Attica Basin. Respondents completed the validated Greek versions of the Moral Distress Scale–Revised, the Jefferson Scale of Empathy for Health Professionals, the 28-item General Health Questionnaire, and the Secondary Traumatic Stress Scale. Participants were asked to complete a paper-pencil data sheet consisting of 27 sociodemographic questions.
A total of 267 out of 350 distributed questionnaires were completed and returned, corresponding to a response rate of 76.3%. The findings showed that nurses experienced moderate MD in both frequency and intensity, moderate-to-high GH and empathy, and moderate levels of STS. Psychiatric nurses reported lower STS and better GH than their counterparts in general hospital settings. Multivariate analysis demonstrated a statistically significant association between increased STS and deterioration in GH. A rise in the frequency of MD is significantly linked to an increase in its intensity.
Incorporating proven screening methods, programs that build resilience, supportive workplace cultures, ongoing evaluations over time, and peer support systems creates a complete approach to lowering moral distress and secondary traumatic stress, improving nurse well-being, maintaining work efficiency, and enhancing the overall safety and quality of healthcare services.
Nurses' burnout, work instability (WI), and job satisfaction (JS) in their practice environment (PE) are well established in the literature. However, perinatal missed care (PMC), a subset of missed nursing care, remains underreported among maternity nurses.
To examine the mediating role of PE and burnout in the associations of WI, JS, and PMC among maternity nurses.
A cross-sectional and correlational study employed consecutive sampling to recruit maternity nurses (n = 312) from five hospitals in Saudi Arabia (three government and two private hospitals in Hail and Makkah regions, respectively). Maternity staff nurses, regardless of their sex, years of professional nursing experience, or nationality, who met inclusion criteria were included in this study. Data was collected from July to September 2024 using four standardized self-report scales. Structural equation modeling was utilized for statistical analyses.
Maternity nurses' WI negatively influenced PE (β = −0.23, p = 0.014), while positively affected PMC (β = 0.15, p = 0.031). The PE positively affected JS (β = 0.24, p = 0.034) but had a negative effect on burnout (β = −0.24, p = 0.007) and PMC (β = −0.21, p = 0.038). Burnout negatively affected JS (β = −0.25, p = 0.028), while positively associated with PMC (β = 0.20, p = 0.022). PE mediated the associations between WI and burnout (β = 0.05, p = 0.019), JS (β = −0.07, p = 0.020), and PMC (β = −0.06, p = 0.008). Meanwhile, burnout mediated between PE and JS (β = 0.05, p = 0.030) and PMC (β = −0.04, p = 0.023).
Understanding the relationships among maternity nurses' burnout, JS, PE, and PMC is key to improving the quality of perinatal care and ensuring the patients' well-being. By focusing on strategies to enhance the PE (e.g., adequate staffing and resources, improved nurse–patient ratio), reduce burnout (e.g., meditation and mindfulness programs, coping intervention programs), and improve JS (e.g., work schedule flexibility, facilitate work-life balance, staff professional development), healthcare organizations can mitigate the occurrence of PMC.
The National Association of Epilepsy Centers (NAEC) published guidelines on caring for patients admitted to an in-patient epilepsy monitoring unit (EMU) in 1997. These guidelines serve as the foundation for nursing practices in this specialized field. However, there is a significant variation in nursing knowledge and confidence in caring for this patient population. This highlights the need for a standardized epilepsy education program for bedside nurses in these units, which is currently lacking.
This initiative aimed to determine the best evidence-based strategies for improving nurse knowledge and confidence in caring for inpatients in the EMU. The evidence-based practice initiative used the seven step process, a systematic approach to implementing evidence-based practice in healthcare. It involves asking a clinical question, searching for the best evidence, critically appraising the evidence, integrating the evidence with clinical expertise and patient values, and evaluating the outcomes.
After completing the first three steps of the process, it was recommended that an educational program be developed. This program included modules on understanding epilepsy, recognizing different seizure types, managing seizures in an inpatient setting, and ensuring patient safety during video-electroencephalography (VEEG).
This initiative showed a significant improvement in nurses' knowledge and confidence in caring for patients admitted to EMU. Notably, the administration of anti-seizure medications (ASMs) became more consistent, and the response to different seizure types was more uniform.
Standardized educational programs for patients admitted to an EMU are needed. The evidence-based education program developed at a free-standing Midwest pediatric hospital may be helpful for nurses in other pediatric EMUs.
Standardized education improves nurse knowledge and confidence, but access and consistency across shifts remain challenges. A structured, evidence-based module series tailored to EMU care enhances nurse preparedness and promotes safer, more consistent patient care. Ongoing education and leadership support are essential to sustain these improvements.
The translation of evidence-based practice (EBP) into routine nursing practice remains a persistent challenge.
To evaluate the impact of a structured EBP Mentor Nurse Training Program, developed using the Johns Hopkins EBP model as a process guide and conceptually grounded in the ARCC (Advancing Research and Clinical Practice through Close Collaboration) model, which emphasizes the development of EBP mentors to enhance implementation and competency.
This quasi-experiment used a pretest-posttest design with equivalent control and intervention groups (n = 52; intervention group = 26, control group = 26). The intervention consisted of a blended training program (16 h face-to-face, 3 h online) covering EBP, mentoring, and communication skills. The control group received no intervention. Data were collected using the Nurse Information Form, the Evidence-Based Practice Evaluation Competency Scale, and the Mentoring Scale. The TREND statement guided reporting.
Post-test results indicated significant improvements in the intervention group's EBP knowledge sub-dimension and total competency scores. Statistically significant gains were also observed in the coaching, role modeling, counseling, acceptance and approval, and friendship sub-dimensions of the Mentoring Scale. Effect sizes ranged from d = 0.5 (coaching) to d = 0.8 (EBP knowledge), indicating moderate to large practical significance.
Structured EBP mentorship programs effectively enhance nurses' knowledge, EBP competencies, and mentoring abilities. These outcomes align with the ARCC model, supporting the cultivation of EBP mentors as a sustainable strategy for EBP integration. Incorporating blended learning and active mentorship in nursing education can foster a culture of collaboration, improve clinical decision-making, and promote better patient outcomes.
Hematological cancers impair patients' quality of life (QoL) due to prolonged and complex treatments. Digital empowerment programs enhance patient engagement by supporting symptom management and psychosocial well-being.
This study was conducted to examine the effects of patient-centered digital empowerment programs on hematological cancer care.
As part of this study, a comprehensive search was conducted in nine databases and the gray literature in March 2025. The screening included randomized controlled trials without any time restrictions. This study adhered to the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Fixed-effect and random-effect models were used in the meta-analysis. Cochran's Q chi-square test and I 2 statistic were applied to assess heterogeneity. Data analysis was performed using the Comprehensive Meta-Analysis (CMA) 3 software.
A total of seven studies were included in this meta-analysis. Patient-centered digital empowerment programs were found to have moderate and positive effects on depression (Hedges' g = 0.27, p < 0.001), distress (Hedges' g = 0.28, p < 0.001), self-efficacy, and QoL (Hedges' g = 0.22, p < 0.001). There was no significant effect on fatigue levels in patients with hematological cancers (p = 0.27), suggesting that digital empowerment programs may not be effective in managing fatigue. The results of the sensitivity analysis support the robustness and reliability of the study findings.
Digital empowerment programs may serve as a moderately effective tool in improving depression, distress, self-efficacy, and QoL among patients with hematological cancers. However, they exhibit limited effects on physical symptoms, particularly in fatigue management. Therefore, more comprehensive and multidisciplinary interventions are needed to address the management of physical symptoms effectively. Patient-centered digital empowerment programs enable early intervention by assisting healthcare professionals in symptom tracking. Digital solutions enhance care processes by improving patient education, psychosocial support, and self-management skills.
The teach-back method is an effective approach for reinforcing patient education by clarifying and reviewing misunderstood concepts.
To examine the effect of discharge training based on the teach-back method on discharge readiness and satisfaction in patients undergoing lumbar disc herniation surgery.
A randomized controlled trial using a pre-test–post-test design was conducted at two state hospitals in Northern Cyprus from November 2022 to December 2023. A total of 64 patients were randomly assigned to either the intervention group (n = 32) or the control group (n = 32). Data were collected using the Discharge Education Satisfaction Scale, the Readiness for Hospital Discharge Scale, and the Discharge Education Knowledge Test. The CONSORT 2010 flow diagram was followed.
The mean ages of the intervention and control groups were 51.26 ± 11.92 years and 46.50 ± 11.73 years, respectively. Following the intervention, patients who underwent lumbar disc herniation surgery in the intervention group showed significantly higher scores compared to the control group (p < 0.05). These improvements were observed in overall discharge education satisfaction, discharge education knowledge, and all subdimensions of discharge readiness–including personal status, knowledge, and coping ability.
Discharge education delivered using the teach-back method enhances satisfaction, knowledge, and discharge readiness in patients undergoing lumbar disc herniation surgery.
Trial Registration: The full research protocol is available at ClinicalTrials.gov (NCT05695014)
Nurse leaders at every level are needed to help organizations achieve strategic goals and deliver safe patient care. Nurse leaders can find fulfillment in their roles; however, they are often prone to poor work-life balance due to the complexity and demands of their jobs. Professional well-being, consisting of an individual's overall health and the perception of good work-related quality of life, is at risk for being compromised in these nurses. Research exploring variables associated with psychosocial well-being in nurse leaders is limited.
To describe variables related to psychological well-being in nurse leaders, explore associations among these variables, and identify potential demographic and psychosocial predictors of resilience and burnout.
Participants were a convenience sample of nurse leaders from two hospitals located in the southwestern United States. We used a prospective observational design to describe the incidence of and relationships between self-compassion, satisfaction with life, resilience, perceived stress, and burnout. We then sought to identify predictors of disengagement and exhaustion (subscales of burnout) and resilience.
Participants (n = 105) were mostly female (82.7%) and white (57.7%), while one-third were charge nurses. Most reported normal to high levels of satisfaction with life (86%), self-compassion (90%), and resilience (93.3%) and 72.4% reported high stress levels. Moderately high levels of disengagement (46.4%) and exhaustion (59.1%) were also present. Higher self-compassion levels predicted higher levels of resilience. Lower satisfaction with life and self-compassion together predicted high disengagement scores, while lower self-compassion scores predicted high exhaustion scores.
When disengagement, exhaustion, and perceived stress are elevated, nurse leaders are at risk for low professional well-being and may be more prone to resignation ideation or turnover. Evidence-based interventions designed specifically for nurse leaders promoting professional well-being and emphasizing self-compassion skills are needed along with high-quality research on program outcomes.
Integrating evidence-based interventions in services by midwives and public health nurses (PHNs) has the potential to improve public health. Attitudes and individual readiness to change can influence the implementation of evidence-based interventions, but there is limited research in community nursing and maternity and child health care services (MCHCs).
To examine attitudes toward evidence-based practice and readiness to change in midwives and PHNs in MCHCs before implementing the “Mamma Mia” intervention (an evidence-based intervention to improve maternal mental health).
A survey-based, multisite cross-sectional study following the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guideline. Data were collected from 190 midwives and PHNs from 42 MCHCs across 33 municipalities in Norway (2021–2022). Six subscales of the Evidence-Based Practice Attitude Scale (EBPAS) assessed attitudes toward evidence-based practice, and the Brief Individual Readiness for Change Scale (BIRCS) measured individual readiness. Descriptive and inferential statistics using frequency tables, Pearson correlation coefficient, and linear regression were used for data analysis. Open-ended responses were analyzed using content analysis.
Sixty-five midwives and 125 PHNs completed the baseline survey (mean age 46.8, all female). Mean EBPAS subscales scores were 2.99 to 3.58 (SD = 0.46–0.77) mean BIRCS score was 3.16 (SD = 0.49) (possible range 0–4). Scores were slightly higher than typically reported in clinical settings, with no significant differences based on demographics (all p-values ≥ 0.166). EBPAS subscores and the BIRCS score showed a moderate positive association. The most frequently reported positive factors influencing readiness were “enhanced care and positive gain” (42.6%), “organizational support” (26.3%), and “receiving training and implementation support” (23.2%). Negative factors included “time constraints and workload” (58.4%), and “research participation and implementation demands” (27.9%).
Midwives and PHNs showed positive attitudes toward EBP and a high degree of individual readiness. Our findings align with previous research highlighting barriers such as time constraints and workload, offering insights to inform strategies for more effective EBP adoption and implementation. These results can guide nurse managers, administrators, policymakers, professional associations, implementers, and intervention developers in enhancing EBP integration into practice.
Nursing well-being is foundational to the specialties workforce and broader healthcare industry worldwide. Despite frequent reports and descriptions of activities that support nurses' well-being, most reports describe singular activities and programs that lack science-based structures contextualized within academic healthcare systems (AHS) with validated impact.
To evaluate and synthesize the existing national and international literature on nurse well-being initiatives offered in AHS.
Over 18 months, an 8-member interprofessional team conducted a scoping review adhering to PRISMA-ScR reporting guidelines. Five databases were searched, and results were screened in a multistep process by researcher pairs. Discrepancies were resolved by a third team member's review. Citations were reviewed uniquely three times to ensure methodological rigor. A final set of 54 articles was extracted for key data elements pertinent to the research question describing setting, population, study design, intervention, and other subsidiary fields. Reviewers additionally analyzed publication quality indicators and trends for additional implications for research and practice.
Among the 54 eligible articles, 72% were research and 28% were evidence-based practice, quality improvement, or doctoral dissertations. The concepts studied were psychosocial (e.g., resiliency) and physical (e.g., sleep). The number of instruments used per study ranged from 1 to 11. Thirty percent of studies utilized a framework from various disciplines that included nursing, social and behavioral sciences, and safety science principles. Nurses were included as authors 67% of the time, and 35% received funding from either the public or private sector.
A skilled and diverse healthcare workforce is essential in nursing homes, yet recruitment and retention remain a major challenge. Gaining insight into the well-being of different care worker groups and how they perceive their work environment can highlight areas of concern and opportunities for improvement.
To compare the perceived work environment and well-being among different care worker groups in nursing homes.
This descriptive study used cross-sectional survey data from the Flanders Nursing Home (FLANH) project, collected from February–July 2023. A total of 1521 care workers from 25 Flemish nursing homes participated (64.4% response rate), including care assistants (43.7%), registered nurses (20.5%), support staff (15.4%), allied health professionals (14.8%), and team leaders (5.7%). Chi-squared tests were used to compare the percentages of the care worker groups reporting the work environment items and well-being outcomes (job satisfaction, intention to leave, burnout). Post hoc analyses were conducted to identify which groups contributed to the significant differences observed.
Significant differences among care worker groups were found for almost all work environment items and well-being outcomes. Staffing adequacy was perceived least among care assistants and registered nurses. More registered nurses and team leaders perceived high workload and emotional burden compared to the other groups. Work–life interference and involvement were perceived most among team leaders. A person-centered vision, work autonomy, and salary satisfaction were reported most among allied health professionals and team leaders. Skill use and training opportunities were reported least among support staff. Work-related well-being appeared to be experienced most among allied health professionals and least among care assistants.
These findings highlight key differences in work environment perceptions and well-being among care worker groups, offering valuable insights for tailored initiatives to foster a supportive workplace that benefits the well-being of all types of care workers in nursing homes.
Work wellbeing, also known as workplace wellbeing, is a global concern for nurses, particularly because excessive stress and exhaustion contribute to burnout.
The Caring Science International Collaborative (CSIC), an international research network, empirically investigates nurse work wellbeing using the Profile of Caring, a psychometrically validated and reliable instrument.
The CSIC framework defines wellbeing intrinsically—as caring and clarity—and extrinsically—as the social and technical resources needed to work efficiently and effectively. The Profile of Caring explains 80% of work wellbeing in nursing without bias across 10 countries.
This research protocol describes an international multicenter observational study that measures nurse work wellbeing using the Profile of Caring and other concepts and outcomes measures.
Evidence-based practice (EBP) is essential for clinical decision-making, integrating the best available evidence, clinical expertise, and stakeholder values. In Italy, interest in EBP is growing, and a key step in its promotion is adopting tools to assess nurses' beliefs and behaviors toward EBP. While the EBP Beliefs Scale has been translated and validated in multiple languages, it has yet to be adapted for the Italian context.
This study aims to adapt EBP measurement tools for the Italian context and evaluate their psychometric properties.
This study used an observational cross-sectional design. The process of cross-cultural translation, adaptation, and validation was adopted. A panel of experts culturally adapted the Beliefs Scales (long and short version) through the item and scale content validity (I-CVI, S-CVI). To test the psychometric properties, 409 nurses were asked to complete the two scales. Confirmatory factor analysis was conducted to validate the factor structure within the Italian context. Convergent validity between the long and short versions of the scale was assessed using the correlation coefficient (r), and the reliability was assessed by computing Cronbach's alpha.
The I-CVI and S-CVI for the long and short version ranged from 0.75 to 1.00. The CFA model performed for the long and short version reported a good fit without the need for further refinements. The Cronbach's alpha was higher than 0.80 for both scales. The correlation of 0.615 (p < 0.01) indicated a moderate to strong positive relationship supporting the convergent validity of the short version in relation to the long version.
In time-constrained settings, the short scale should be utilized for efficient assessments and longitudinal tracking of changes. The long version serves as a complementary tool for in-depth analysis, facilitating a deeper understanding of underlying factors and informing targeted interventions to address specific barriers.
A call for action has been issued nationwide to prevent suicide among nurses. An increased understanding of contributing and protective factors associated with suicidal ideation in nurses is needed to implement preventive measures. Factors needing exploration include nurses' burnout, mental well-being, physical health, and workplace characteristics.
This study aimed to determine factors associated with suicidal ideation in 501 moderate-to-high-risk nurses, including their mental health, level of burnout, health-related personal beliefs, healthy lifestyle behaviors, and workplace characteristics.
A descriptive, cross-sectional correlational study was conducted on baseline survey data that was completed before the nurses were randomized to one of two interventions as part of their participation in a randomized controlled trial investigating the efficacy of a combined mental health screening program and cognitive-behavioral skills building intervention versus a screening program alone. Nurses were recruited from across the United States via email. Only nurses identified with moderate-to-high-risk adverse mental health outcomes, including suicidal ideation, were included. The survey used valid and reliable measures to assess burnout, anxiety, depression, suicidal ideation, post-traumatic stress, healthy lifestyle behaviors, health-related personal beliefs, resilience, job satisfaction, self-perceived mattering to the workplace, and intent to leave. Bivariate tests were performed.
Burnout, anxiety, depression, and post-traumatic stress were individually correlated with increased odds of suicidal ideation, as were nurses working 12-h shifts and those who reported an intent to leave their jobs. Protective factors against suicidal ideation included resilience, positive health-related personal beliefs, healthy lifestyle behaviors, job satisfaction, and workplace mattering.
There is an urgent need for policies and implementation of evidence-based interventions to address mental health issues in nurses to ultimately prevent suicide. Burnout should be considered as a possible precursor to serious adverse mental health problems and not just an operational retention issue. Leaders need to invest in resources to enhance nurses' mental health, fix system problems that are at the root cause of burnout, routinely recognize employees for their excellent work, and communicate that they matter. Leaders should listen carefully to their nurses, prioritize their ideas for impactful change, and appreciate those who contribute to improving culture and caring practices.
Work-related stressors have been associated with physician suicide. Physician burnout and depression were exacerbated by the COVID-19 pandemic, remain unresolved and of national concern. Future pandemics are predicted. This study is the first to characterize professional and pandemic-related stressors in physician suicides during the COVID-19 pandemic.
This study aimed to evaluate whether there was a change in reported job-related stressors after the beginning of the COVID-19 pandemic.
Physician suicides were identified within the National Violent Death Reporting System dataset (March 1, 2020 to December 31, 2021). Free-text law enforcement and medical examiner notes for physician suicides were analyzed using reflexive thematic analysis.
Of 307 physician suicides, 70 included professional or pandemic-related stressors associated with death. Themes included pandemic-related dysregulation, financial distress, relationship issues, mental/physical/substance use problems, grief, and discipline.
While loss of employment, physical, mental health, legal, and substance use issues continue to be associated with suicide, grief and pandemic-specific stress were novel findings. Fear of disease, quarantine, and prolonged illness due to contracting COVID warrant psychological support. Psychological support is also indicated for recent discharge, grief management, transition into retirement, and during disciplinary processes. The stress of a pandemic may exacerbate previous risks. Proactive physician suicide prevention measures remain indicated.
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