Conectar
To explore how neonatal nurse leaders sustain human-centred care while implementing digital technologies in neonatal intensive care units (NICUs).
Qualitative descriptive multi-site study across four NICUs in the Eastern Region of Saudi Arabia (November 2024–May 2025), reported in accordance with COREQ.
Purposive maximum-variation sampling recruited 24 neonatal nurse leaders across leadership levels, hospital types and digital maturity stages. Semi-structured interviews were conducted in Arabic or English, transcribed, translated as needed and thematically analysed in NVivo 14 using a hybrid inductive–deductive approach. Directed content analysis of key organisational documents enabled triangulation. Trustworthiness was supported through member checking, peer debriefing, audit trail, external review and double coding of a subset of transcripts.
Four interrelated strategies were identified: (1) embedding a values-based human-centred vision; (2) selecting and customising digital tools to strengthen, not replace, nurse–family connection; (3) redesigning workflows (e.g., device-free openings, protected presence time, family-inclusive portals) to preserve presence and partnership; and (4) fostering team capability and psychological safety for digital–human integration.
Human-centred care in digital NICUs is intentionally led and structurally engineered. The study offers a practice-ready framework that translates values into reproducible routines within complex sociotechnical systems.
The framework supports nurse leaders in aligning digital transformation with family-centred care, protecting nurse–family presence, and enhancing safety, trust and partnership for high-risk neonates.
Addresses risks of relational erosion in digital and AI-enabled NICUs and provides transferable nurse-led strategies to sustain ethical, family-centred practice.
COREQ-compliant qualitative study.
No Patient or Public Contribution.
Monitoring physical rehabilitation is an essential component of patient recovery after knee arthroplasty. Monitoring can be remote, or clinic based. In India, unsupervised home-based physical rehabilitation is a common practice, but there is a lack of evidence to demonstrate the effectiveness of remote monitoring. Therefore, we developed and piloted a mobile application (TeleREhabilitation after knee ArThroplasty app) based on behaviour design thinking to support the recovery period. This trial aims to compare the effectiveness, acceptability, cost and safety of this app-supported home-based intervention against usual care using an open label, 1:1 individual randomised superiority trial at two tertiary care hospitals in India.
Consecutive adults undergoing partial or total, unilateral or bilateral knee arthroplasty who can use a smart phone will be invited to participate in this trial. Consenting individuals will be randomised to either an app-supported intervention or a usual home-based rehabilitation which typically consists of provision of oral or written instructions at discharge and follow-up check-up with the surgeon or physiotherapist at their discretion or as per individual need. We aim to recruit 300 individuals over a period of eighteen months. The primary objective is to compare patient-reported knee function between the two groups at 3 and 6 months postsurgery. Secondary objectives are to compare patient-reported outcomes (pain and activity), performance-based outcomes (lower limb strength and knee function), resource utilisation and quality of life. Fidelity of implementation, end-user experiences and challenges in implementing this intervention will be measured using both quantitative and qualitative methods. Quantitative data will be analysed in Stata, and group comparisons will be done using mixed effect linear regression. A mixed-methods approach will be used to analyse and interpret the process evaluation data. A modified intention-to-treat approach will be taken, which includes all those who were randomised irrespective of their adherence to trial protocol if they had at least one follow-up visit after enrolment.
The protocol has been approved by the ethics committees of the sponsor institute (The George Institute for Global Health) and the two clinical sites (All India Institute for Medical Sciences, Delhi & Indraprastha Apollo Hospitals, Delhi). The results will be disseminated via peer-reviewed publications, conference presentations and via plain language newsletters to the trial participants.
CTRI/2024/06/068838.
This study aims to identify the impact of climate change anxiety and asthma control on asthmatics' quality of life and examine the moderating role of climate change anxiety in this linkage.
A multi-national cross-sectional study was conducted in four Arabian countries on 1266 asthmatics selected by convenience sampling. Data were collected from November 2023 to February 2024 using a climate anxiety scale, mini-asthma quality of life questionnaire, and an asthma control questionnaire.
Climate anxiety was higher among middle-aged participants, as well as those with longer disease durations and previous hospitalisations. Climate anxiety showed strong negative correlations with asthma control (r = −0.704, p ≤ 0.05) and asthma quality of life (r = − 0.638, p ≤ 0.05). Climate anxiety and asthma control are powerful predictors of quality of life among asthmatics. Climate anxiety moderates the relationship between asthma control and quality of life, making it less positive (B = −0.094, p > 0.001). Covariates such as gender, age, comorbidities, employment status, disease duration, and previous hospitalisation showed significant associations with asthma quality of life.
Assessment and mitigation of climate anxiety among asthmatics is a key strategy for controlling asthma and improving the quality of life. So, nurses must incorporate climate anxiety assessment into the care plan for asthmatics.
Climate change is a global concern, and insights into how climate-related psychological stressors exacerbate asthma symptoms and overall health outcomes are necessary. The findings provide actionable data for healthcare professionals to underscore the need for integrated healthcare approaches considering environmental and psychological factors.
This study adheres to strengthening the reporting of observational studies in epidemiology (STROBE) statement.
Clients with asthma across multiple nationalities actively contributed to our paper.
To investigate the association between emotional responses to climate change, antenatal anxiety, and maternal–fetal attachment in primigravida women.
A multi-site cross-sectional research design study.
This study was conducted at four primary health care (PHC) facilities in Damanhur district, El-Behera, from February 2024 to April 2024. Two hundred eighty-five women completed a comprehensive questionnaire that included a Woman's Social and Reproductive Form, The inventory of climate emotions (ICE) scale, The Stirling Antenatal Anxiety Scale (SAAS) and the Maternal–Fetal Attachment Scale (MFAS-HU-20).
The study revealed that emotional responses to climate change show strong positive correlations with each other, ranging from 0.689 to 0.840, all significant at p < 0.001 level. Additionally, antenatal anxiety demonstrates substantial positive correlations with emotional responses to climate change, albeit with associations ranging from 0.239 to 0.287, all significant at p < 0.001 level. Moreover, maternal–fetal attachment displays substantial negative correlations with emotional responses to climate change, indicating that as emotional responses to climate change increase, maternal–fetal attachment tends to decrease. The correlations range from −0.263 to −0.426, all significant at p < 0.001.
The emotional impact of climate change can adversely affect the bonding process between mother and fetus.
Healthcare professionals, including obstetricians, midwives, and mental health counsellors, should integrate climate-related emotional distress into their assessments and interventions. Providing targeted psychological support for expectant mothers.
The study's findings highlight the need for nursing to integrate climate-related emotional distress screening into prenatal care and for research to explore long-term effects and intervention effectiveness. In practice, healthcare providers should adopt holistic approaches that combine environmental and psychological support, developing comprehensive guidelines and community-based programs to support pregnant women.
The research adhered to that is STROBE.
Public contributions by women in community health centers.
The Munich Security Conference 2024 highlighted the complex connections between climate change and global security risks. Engaging students in fighting climate change is a stepping stone to achieving the Sustainable Development Goals.
To investigate the effect of a video-based climate change program on revitalising eco-cognizance, emotional response, and self-efficacy among nursing students in rural communities.
A randomised controlled trial research design was adopted.
A total of 140 nursing students completed a survey related to the Climate Change Perceptions, the Climate Change Anxiety Scale, and the Environmental Self-Efficacy Scale. The study group engaged in the video-based climate change program, while the comparison group received flyers related to climate change across the globe.
The intervention group significantly improved climate change perception and environmental self-efficacy compared to the control group, with large effect sizes. On the other hand, significantly lower levels of cognitive impairment due to climate change anxiety were recorded among the intervention group compared to the control group.
Our intervention improved nursing students' climate change literacy, pro-environmental attitudes, environmental self-efficacy, and anxiety. Future research may target a variety of university majors and use RCTs nested in a mixed-method design to capture the student experience with climate change before and after the RCT.
This study demonstrated that a comprehensive educational program significantly improved climate literacy, pro-environmental attitudes, and environmental self-efficacy among undergraduate nursing students while reducing climate anxiety. The findings of this study offer valuable insights for enhancing student nurses' ability to translate their scientific understanding into informed decision-making regarding issues like climate change.
Drastic natural disasters, including extreme temperatures, flooding, wildfires and snow and sandstorms, significantly affect populations, including nursing students. Early screening and management of climate change anxiety among university students is recommended as a buffer against upcoming mental health issues. Student counselling services are urged to consider the effect of climate change as a mental health parameter that significantly affects students' psychological and, consequently, academic life and progress. A video-based climate change program (VBCCP) is beneficial for equipping students with climate change literacy. The revitalization of the participant's overall eco-emotional response, pro-environmental behaviour and cognizance signalled the potential of VBCCP as a simulation teaching tool that might be integrated into nursing curriculums. Additionally, VBCCP is a cost-effective strategy that complies with International Nursing Association for Clinical Simulation and Learning (INACSL) requirements. The VBCCP can be delivered in the conventional classroom environment or through the digital platform without incurring additional costs and in alignment with the definition of simulation provided by the Agency for Healthcare Research and Quality.
No public or patient contributions.
RCT registration: NCT06223412, on 23rd January 2024
To provide a comprehensive understanding of the cultural adaptation and professional integration experiences of migrant nurses in the receiving country.
A convergent parallel mixed methods design with concurrent sampling was employed.
Professional nurses who migrated from various Middle Eastern and North African countries, including Egypt, Syria, Palestine, Yemen, Jordan, Iraq and Saudi Arabia, were enrolled. The Quantitative data was collected through an online questionnaire involving open-ended questions for the qualitative data. Data was collected from November 2023 to March 2024.
One hundred five nurses responded to the quantitative questionnaire, and 32 answered the open-ended questions. The findings revealed that mean scores for cultural competence and professional self-concept were 83.41 ± 12.90 and 76.28 ± 11.16, respectively. Migrant nurses experienced challenges such as language barriers (91.4%), social interaction (82.9%) and difficulties adapting to daily living activities (100%). The majority of them reported positive outcomes as better working conditions (91.4%), higher standard of living (89.5%) and professional development opportunities (94.3%). Nurses emphasised accepting cultural diversity, participating in cultural competency training, building relationships with local colleagues and utilising support mechanisms and mentorship for cultural adaptation.
This study highlighted the importance of support systems, cultural competency training and integration initiatives to facilitate successful adaptation and professional integration.
Orientation programs and cultural competency training should be developed to support migrant nurses. Initiatives should include language acquisition support, financial assistance for certification programs and promotion of diversity and inclusion in healthcare settings.
This study addressed the challenges migrant nurses face when transitioning to a new cultural and professional environment. It found that migrant nurses experience difficulties with language, social interaction and daily living activities. The research impacted healthcare institutions by guiding the development of orientation programs and cultural competency training, supporting policymakers in addressing systemic barriers and empowering migrant nurses with practical strategies for adaptation.
This study adhered to the Good Reporting of A Mixed Methods Study (GRAMMS).
No patient or public involvement.
Gluteal tendon tears—frequently dubbed the ‘rotator cuff tears of the hip’—are a common but often underdiagnosed cause of lateral hip pain and abductor dysfunction, especially in middle-aged to older women. While both open and endoscopic repair techniques are used, current literature suggests similar functional outcomes but higher complication rates following open repair. However, evidence is mainly derived from small retrospective case series, and no randomised trials exist. This systematic review and multilevel meta-analysis aims to compare the efficacy, safety and complication profiles of endoscopic versus open gluteal tendon repair.
A comprehensive literature search will be conducted across PubMed, Embase, CENTRAL and Epistemonikos without language or date restrictions. Eligible studies include randomised controlled trials and observational studies reporting on open or endoscopic gluteal tendon repair. Primary outcomes will include pain, functional scores and complication rates. Risk of bias will be assessed using the RoB 2 tool for RCTs and ROBINS-I for non-randomised studies. A three-level random-effects meta-analysis will be performed using inverse variance weighting and Hartung-Knapp adjustments. Heterogeneity will be quantified using the I² statistic.
Ethical approval is not required for this secondary analysis of published data. Results will be disseminated via peer-reviewed publication and conference presentations.
The review will commence immediately after acceptance of this study protocol in BMJ Open. The systematic review and multilevel meta-analysis will be conducted as efficiently as possible, with anticipated completion approximately 3–6 months after initiation.
CRD420251088765
Suicide has a substantial economic burden, yet in low- or middle-income countries, the analysis is constrained by the absence of disaggregated economic data. Existing studies primarily rely on gross costing methods, overlooking sector-specific costs such as healthcare, law enforcement and productivity losses at the family and community levels. Furthermore, the societal perspective, essential for understanding the multifaceted economic impacts of suicide, remains insufficiently explored in the Indian context.
This study will quantify the economic burden of suicide and suicide attempts in India. The initial phase will involve developing a resource-use measure instrument to capture the societal costs associated with suicide. Subsequently, a retrospective, incidence-based study will be conducted in India using the developed instrument. This will also be complemented with the Health-Related Quality of Life Assessment using EuroQOL (EQ-5D-5L). Exploratory subgroup cost comparisons (eg, suicide methods, healthcare facility type) will use non-parametric tests, including the Mann–Whitney U and Kruskal–Wallis tests. Generalised linear mixed models (gamma distribution and log link) will analyse longitudinal cost and HRQoL data, besides bootstrapping techniques and sensitivity analyses.
Ethics approval was obtained for the study from the institutional review board of the Indian Law Society (ILS/141/2024). All data collected during the study will adhere to ethical guidelines, taking informed consent. The findings of the study will be disseminated through peer-reviewed journals to aid data-driven decision-making.
Clinical Trial Registry of India (CTRI/2025/02/080380), date of registration: 12/02/2025.
School nurses are sometimes the sole healthcare professionals in schools, highlighting their significant role in delivering emergency care and the vital necessity of their competence in emergency nursing care. The scope of practice and ongoing professional development are hypothesized to play significant roles in enhancing these competencies.
Investigate the direct and indirect effects of the scope of current practice and the importance of training on the emergency nursing care competency of school nurses, with career growth serving as a potential mediator.
A multi-center cross-sectional study was conducted with a convenient sample of 219 school nurses. Data were collected using the career growth of nurses' scale, the emergency nursing care competency scale for school nurses and the scope of school nursing practice tool. Mediation analysis was used to explore the direct and indirect effects of studied variables.
Mediation analysis indicated that the scope of current practice had a significant direct effect on career growth (β = 0.179) and emergency nursing care competency (β = 0.389). The importance of practice also had significant direct effects on career growth (β = 0.164) and emergency nursing care competency (β = 0.220). Additionally, career growth significantly mediated the relationship between both the scope of current practice (β = 0.110) and the importance of practice (β = 0.120) with emergency nursing care competency.
The findings emphasis the critical role of career growth as a mediator between the scope and importance of practice and emergency nursing care competency among school nurses. Expanding the scope of practice and emphasising the importance of professional activities can enhance career growth and improve emergency nursing care competencies.
Nurses scope of practice and clear career advancement through mentorship, advanced certifications, further education and enforcing policies mandating regular emergency care is crucial. Establishing a regulatory framework to define and expand the scope of practice for school nurses is also important.
No patient or public contribution.
Although multimodal rehabilitation programs are effective for substance use disorders and widely used, addiction is still a global socioeconomic problem. Providing practical strategies, such as the HeartMath intervention for managing stress at the moment, helps mitigate the physical, emotional, and psychological impacts associated with substance use disorder, promotes resilience, and enhances treatment motivation.
To investigate the effects of the nurse-led HeartMath Training Program on resilience, emotional adjustment, and treatment motivation among patients with substance use disorder.
A randomized controlled trial (RCT) was used to carry out this study. This study was conducted at the inpatient unit for patients with addiction at Elmaa'mora Hospital for Psychiatric Medicine in Alexandria, Egypt. The subjects were 130 patients with substance use disorders (65 in each group). Researchers used three tools to collect the necessary data: Tool I Resilience Scale, Tool II Brief Adjustment Scale–6, and Tool III Treatment Motivation Questionnaire.
The difference in resilience, emotional adjustment, and treatment motivation between the study and control groups after the Nurse-Led HeartMath training intervention was statistically significant.
The HeartMath Training Program is efficacious in improving resilience and emotional adjustment among patients with substance use disorder and increasing their treatment motivation.
ClinicalTrials.gov identifier: NCT06437366
Diabetes mellitus is a growing global health concern, with a high prevalence in Egypt. Type 2 diabetes imposes substantial health and economic challenges. Diabetes Self-Management Education and Support (DSMES) programs, such as the Diabetes Conversation Map, have demonstrated promise in enhancing patient knowledge, self-management, and self-efficacy. However, evidence regarding their direct impact remains scarce, necessitating further investigation.
This study aimed to evaluate the effectiveness of the Diabetes Conversation Map program in improving knowledge retention, self-management, and self-efficacy among type 2 diabetes patients in Egypt.
A prospective, parallel, two-arm randomized controlled trial was conducted at the Damanhour Health Insurance Outpatient Diabetic Clinic in Egypt. A total of 120 adult patients with type 2 diabetes were randomized into a control group (n = 60), receiving standard diabetes education, and an intervention group (n = 60), attending 8 weekly interactive sessions using the Diabetes Conversation Map. Primary outcomes were assessed using validated questionnaires at baseline, post-intervention, and 3 months later.
The intervention group exhibited significant improvements in knowledge, self-management, and self-efficacy compared to the control group (p < 0.001). Additionally, positive correlations between these outcomes were observed post-intervention, replacing negative correlations observed at baseline.
The Diabetes Conversation Map program effectively enhances patient knowledge, self-management, and self-efficacy, supporting its integration into routine diabetes education. Healthcare providers should implement structured, interactive educational interventions to empower patients in managing their condition. Regular follow-ups and reinforcement strategies are necessary to sustain long-term self-efficacy improvements. Policymakers should consider incorporating evidence-based diabetes education into national healthcare programs. Future research should explore digital adaptations of the program to enhance accessibility and engagement.
Registration No: R000061691, Trial ID: UMIN000054044
To examine the impact of climate anxiety on the quality of life (QoL) of patients with COPD. It also explores how climate anxiety interacts with clinical factors, such as disease severity and comorbidities, to influence QoL.
Cross-sectional.
A total of 270 COPD patients were recruited using a convenience sampling method. Data were collected through structured interviews and clinical assessments, incorporating the Climate Anxiety Scale, the St. George's Respiratory Questionnaire and the BODE Index. Hierarchical multiple regression analysis was performed to determine the predictors of QoL.
The study found a statistically significant association between climate anxiety and both QoL (r = 0.81, p < 0.01) and COPD severity (r = 0.76, p < 0.01). COPD severity (B = 4.68, p < 0.01) and climate anxiety (B = 0.28, p < 0.01) were predictors of QoL. Among the covariates, former smokers, older patients and multiple comorbidities reported significantly worse QoL (B = 4.80, p = 0.03; B = 0.43, p < 0.01; B = 0.85, p = 0.02, respectively). Collectively all predictors explained 86% of the variance in QoL.
Climate anxiety significantly contributes to reduced QoL in COPD patients, beyond disease severity and demographic factors. Addressing psychological distress in COPD management is essential to improving patient outcomes.
Nurses should recognise climate anxiety as a key variable influencing COPD management. Incorporating climate anxiety screening into nursing assessments and providing targeted interventions can enhance patient support and improve overall COPD care.
Climate anxiety is an emerging concern in COPD. While previous research has focused on physical and clinical determinants of COPD-related QoL, climate anxiety remains underexplored. This study provides new evidence that climate anxiety is a predictor of poorer QoL, highlighting the need for holistic nursing interventions that address both physical and psychological health.
This study was reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE).
Patients with COPD were involved in this study.
FreshRSS 