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Genomic science and the nurse educator's role: Promoting integration from curriculum to clinical practice.

BACKGROUND: Registered nurses and nurse educators play a critical role in preparing future clinicians to translate genomic discoveries into practice. However, emerging evidence suggests that both groups may lack sufficient knowledge and confidence in genomics, potentially limiting their ability to teach, mentor, and apply genomics in real-world settings. This gap is especially concerning in Aotearoa New Zealand, where the genomic literacy of nurse educators and clinicians remains underexplored. OBJECTIVE: This study aims to: (1) assess nurse educators' genomic literacy and confidence in teaching genomics; and (2) evaluate registered nurses' knowledge and confidence in applying and teaching genomics in clinical practice. DESIGN: Exploratory descriptive qualitative. SETTING: This study was conducted in the greater Auckland area. PARTICIPANTS: A total of 17 participants were recruited using purposive sampling to ensure a diverse range of perspectives across varying levels of teaching experience, disciplinary backgrounds, and exposure to genomic content. METHODS: Data were collected using semi-structured focus group interviews, a method well-suited for generating in-depth discussion and facilitating interaction among participants with shared professional interests. The collected data were analysed using thematic analysis methods. RESULTS: The findings offer insight into the preparedness of New Zealand's nursing workforce to engage with genomic-informed healthcare and inform strategies for integrating genomics into nursing curricula and continuing professional development. Given the interdisciplinary nature of genomic healthcare, these insights may also be relevant to other health professionals-including midwives, pharmacists, and allied health practitioners-who increasingly encounter genomic information in clinical practice and require foundational competencies to support patient care. CONCLUSION: Addressing this educational gap is critical to ensuring that nurses-key facilitators of patient care and public health-are equipped to deliver safe, equitable, and evidence-based genomic healthcare.

Humans

Advancing nursing education through social and emotional learning: A systematic review guided by the Collaborative for Academic, Social, and Emotional Learning framework.

BACKGROUND: With Generation Z entering the nursing workforce in growing numbers, strengthening social and emotional learning is critical for academic success, professional adaptation, and safe practice. However, the existing evidence remains fragmented because of varied interventions and inconsistent approaches. OBJECTIVES: This systematic review examined (1) the social and emotional learning essential for nursing students and nurses within the Collaborative for Academic, Social, and Emotional Learning framework, (2) their impact on educational and clinical outcomes, and (3) implications for advancing nursing education and practice. METHODS: Following Joanna Briggs Institute methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, five international (PubMed, EMBASE, CINAHL, PsycINFO, Cochrane) and three Korean (RISS, KoreaMed, KMBASE) databases were searched up to June 2025. Eighteen studies involving 2,952 participants met the inclusion criteria, including quasi-experimental quantitative studies, descriptive quantitative studies, qualitative studies, and mixed-methods studies. The methodological quality of the included studies was appraised using the Mixed Methods Appraisal Tool. RESULTS: Within the Collaborative for Academic, Social, and Emotional Learning framework, relationship skills and self-management were the most frequently studied competencies, emphasizing teamwork, communication, and stress regulation. Self-awareness and social awareness were underexplored, despite their importance in empathy, resilience, and reflective practice. Responsible decision-making was the least studied competency, despite its importance in ethical reasoning. Social and emotional learning was consistently associated with enhanced adaptation, communication, leadership, relationships, and clinical performance. Effective strategies included blended learning, simulation, reflective activities, and mentorship, which are aligned with Generation Z's learning preferences. CONCLUSION: Although social and emotional learning integration is associated with improvements in educational and clinical outcomes in nursing, current research has largely centered on relational and stress-related competencies while underrepresenting responsible decision-making. To cultivate reflective, empathetic, and ethically grounded nurses, curricula should integrate social and emotional learning through a balanced and structured approach. REGISTRATION: This study was registered on PROSPERO (ID: CRD420251005683).

Humans

Effectiveness of artificial intelligence in nursing simulation education: A systematic review, meta-analysis and bibliometric visualization analysis.

OBJECTIVES: To synthesize the roles and core functions of AI in nursing simulation education for nursing students via systematic review, quantitatively evaluate its effects on students' knowledge and skill outcomes through meta-analysis, and map the research landscape and development trends of this field through bibliometric visualization analysis. DESIGN: Systematic review, meta-analysis and bibliometric visualization analysis. DATA SOURCES: Eight electronic databases: PubMed, Web of Science, MEDLINE, ERIC, Academic Search Complete, China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP Chinese Science and Technology Journal Database (VIP) were employed to search studies from the time of construction to 16 December 2025. REVIEW METHODS: Studies meeting the inclusion criteria were screened. The revised Cochrane Risk of Bias tool (ROB 2) and Joanna Briggs Institute (JBI) critical appraisal checklists were used for quality assessment. Meta-analysis was performed with Review Manager 5.4, and bibliometric visualization analysis was conducted using VOSviewer 1.6.20 and Bibliometrix (based on R4.4.3). RESULTS: A total of 61 studies were included. AI primarily played two roles in nursing simulation education: peer-type new subject (n = 24) and direct mediator (n = 22). Meta-analysis showed that AI interventions significantly improved nursing students' knowledge (SMD = 1.49, 95% CI [0.55,2.43], p = 0.002) and skills (SMD = 0.66, 95% CI [0.02,1.31], p = 0.04). Bibliometric analysis identified that the United States of America and China were the two main contributing countries in this field, and the key motor themes included generative artificial intelligence, virtual patients, and geriatric care. CONCLUSIONS: AI exerts positive effects on nursing students' knowledge acquisition and skill enhancement in simulation education, with peer-type new subject and direct mediator as the dominant roles. Future research should focus on expanding AI applications in multi-specialty simulation scenarios, activating the data-driven value of machine learning, and strengthening international collaboration and standardization construction, so as to promote the sustainable development of AI-integrated nursing simulation education.

Humans

Effects of extended problem-based learning interventions on undergraduate nursing education: A systematic review.

OBJECTIVE: Exploring the effects of long-term PBL (problem-based learning) intervention on undergraduate nursing students. METHODS: The article retrieved literature from CINAHL Complete, Academic Search Complete, Web of Science, PubMed, EMBASE, OVID, and Cochrane Library up to January 2025. Studies had to meet all of these criteria: (1) They used a randomized controlled trial (RCT) and quasi-experimental design. (2) The PBL pedagogy intervention lasted 4 weeks or longer. (3) The participants were undergraduate nursing students. (4) They reported primary outcomes. These included critical thinking, problem-solving skills and self-directed learning. Two researchers screened articles, extracted data, and assessed quality independently using blinding. They used Cochrane ROB2 for RCTs and ROBINS-I for quasi-experimental studies to judge bias risk. Meta-analysis was performed using RevMan 5.4 software. For continuous variables, standardized mean difference (SMD) and 95% confidence interval were calculated. Heterogeneity was assessed by I2 statistic. When I2 > 50%, sensitivity analysis was conducted. The source of heterogeneity was explored by excluding studies one by one. The primary outcomes included standardized critical thinking, problem-solving, and self-directed learning assessment results. RESULTS: A total of 11 randomized controlled trials and quasi-experimental studies were retrieved and included for meta-analysis. The experimental group significantly outperformed the control group in critical thinking, problem-solving, and self-directed learning, with differences being statistically significant (P ≤ 0.05). However, high heterogeneity was observed. After sensitivity analysis, the heterogeneity was reduced and the results remained statistically significant, indicating that the findings were not solely dependent on the excluded studies.

Problem-Based Learning

Comparative effectiveness of game-based learning modalities in nursing and medical education: a systematic review and Bayesian network meta-analysis.

BACKGROUND: Game-based learning (GBL) is increasingly used in healthcare education, but educators must choose among diverse modalities (e.g., quiz platforms, apps, serious games and metaverse environments). Comparative evidence on which modalities perform best across learning domains (knowledge, attitudes, and practice) remains limited. AIM: To compare the effects of distinct GBL modalities on knowledge, attitudes, and practice outcomes in nursing and medical education and to explore whether comparative effects differ by learner group (pre-licensure students and in-service professionals). DESIGN: PRISMA-NMA-aligned systematic review and Bayesian network meta-analysis. METHODS: We searched eight databases and trial registries through September 2, 2024, for randomized controlled trials comparing GBL with traditional teaching (TT). Outcomes were transformed to a 0-100 scale and analysed as change from baseline in Bayesian consistency models; random-effects models were selected using deviance information criterion (DIC). Risk of bias was assessed using RoB 2. We report mean differences (MDs) with 95% credible intervals (CrIs) versus TT, ranking probabilities, and subgroup NMAs by learner group. RESULTS: Thirty-one RCTs (n = 3439) were included; 15 contributed complete data to the network. Risk of bias was low in 15 trials and raised some concerns in 16. The network was modest for knowledge (11 trials) and sparse for attitudes (3) and practice (4). Compared with TT, metaverse-based learning showed improved attitudes (MD 15; 95% CrI 12 to 18), based on a single trial. For knowledge and practice, Kahoot-based quizzes (MD 9.1; 95% CrI -8.9 to 27) and app-based learning (MD 4.6; 95% CrI -4.4 to 14) had the highest estimated mean improvements, but credible intervals were wide and included the null for most comparisons. Subgroup rankings differed by learner group, but several comparisons were imprecise and uncertainty was substantial, particularly in sparse networks. CONCLUSIONS: GBL modalities may improve learning outcomes compared with TT, but relative effects appear domain-specific and the certainty of rankings is limited by sparse evidence and imprecision. Future trials should prioritise head-to-head comparisons, robust outcome measurement, and longer-term retention and transfer outcomes in both student and in-service populations.

Humans

Preregistration nursing student attrition and strategies to improve student retention in university; an umbrella review.

BACKGROUND: Attrition among preregistration nursing students remains a persistent international challenge, contributing to nursing workforce shortages. Although extensive research has examined factors influencing student attrition and retention, the evidence is fragmented across review-level literature, limiting clarity regarding priority and evidence-informed retention strategies. AIM: To synthesize review-level evidence on factors associated with preregistration nursing student attrition and to identify strategies that support student retention in university-based nursing programs. METHODS: An umbrella review was conducted in accordance with the Joanna Briggs Institute methodology. Six electronic databases were systematically searched for peer-reviewed literature reviews published in English between January 2016 and October 2025. Eligible reviews focused on undergraduate preregistration nursing students in face-to-face university programs. Methodological quality was appraised using the JBI critical appraisal checklist. Findings were synthesised using narrative and thematic approaches. RESULTS: Seventeen literature reviews were included. Attrition was consistently described as multifactorial, influenced by academic preparedness, psychosocial wellbeing, socio-demographic factors, and institutional support. Retention strategies reported across reviews were predominantly relational, developmental, and sustained over time, including mentoring, tutoring, academic skills development, psychosocial support, and interventions that foster belonging. Faculty engagement and holistic approaches were repeatedly associated with improved student persistence. However, the evidence base was largely descriptive, with limited experimental evaluation of intervention effectiveness. CONCLUSION: Preregistration nursing student retention is best supported through multifaceted, sustained strategies that begin at admission and extend throughout the curriculum. While current evidence highlights consistent patterns of effective support, further rigorous research is required to evaluate retention interventions and extend evidence to flexible nursing education pathways.

Humans

A flipped classroom approach compared with low-interactive online learning for pediatric pain management knowledge and instructional motivation in nursing students: A randomized controlled study.

AIM: This study aimed to compare a flipped classroom approach with low-interactive online learning in terms of nursing students' questionnaire-assessed pediatric pain management knowledge and instructional motivation. BACKGROUND: Pain management in children is a critical and multidimensional nursing responsibility. However, limited curricular time and opportunities for applied learning may restrict nursing students' preparedness in this area. Structured and interactive instructional formats, such as the flipped classroom, may support knowledge acquisition and motivation in pediatric nursing education. METHODS: This study employed a parallel-group randomized controlled trial design with a 1:1 allocation ratio. Eighty-eight third-year prelicensure nursing students were randomized to either the flipped classroom group (n = 44) or the low-interactive online learning group (n = 44). Due to attrition (2 intervention, 2 control), analyses included 42 participants per group (n = 84 in total). Data were collected between February and July 2022 using the Pediatric Pain Management Knowledge Scale for Nursing Students and the Instructional Materials Motivation Survey. This study was prospectively registered at ClinicalTrials.gov (Identifier: NCT07129044). RESULTS: At baseline, the groups were comparable in terms of knowledge and learning motivation. Following the intervention, the flipped classroom group demonstrated greater improvements in questionnaire-assessed pediatric pain management knowledge and instructional motivation than the low-interactive online learning group. Although scores declined from post-test to the three-month follow-up, they remained above baseline in the flipped classroom group. CONCLUSIONS: Within the context of this course, the flipped classroom approach was associated with greater improvement in questionnaire-assessed pediatric pain management knowledge and instructional motivation than low-interactive online learning. The findings should be interpreted as proximal educational outcomes rather than evidence of improved clinical competence or durable long-term effectiveness. Further studies using objective performance-based outcomes and longer follow-up periods are needed.

Humans

Nursing students' perspective of dignity: A systematic review.

AIM: This review synthesizes research on nursing students' perceptions of dignity shaped by education and clinical experiences. BACKGROUND: Respect for human dignity is central to nursing ethics. While dignity is well studied in patient care, less focus has been given to how nursing students perceive and experience dignity during their education. DESIGN: A systematic review of quantitative, qualitative, and mixed-methods studies. METHODS: A comprehensive search was conducted across the Medline, PubMed, ScienceDirect, Scopus, and Web of Science databases for English-language studies published from 2000 to 2025. Quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist and the Mixed Methods Appraisal. Tool. Data were synthesized thematically. Reporting followed PRISMA guidelines. RESULTS: A total of 24 articles were included. Students viewed patient dignity as linked to respect, privacy, and autonomy. Although students had solid theoretical knowledge, they encountered institutional and professional barriers in delivering dignified care. Supportive environments and participation in decision-making enhanced their sense of dignity. Finally, educational strategies such as role-playing, simulations, and empathy exercises enhanced emotional and psychosocial awareness. CONCLUSIONS: These findings indicate that dignity is crucial in shaping nursing students' professional identity and ethical awareness throughout their education. Reinforcing ethical values and dignity in nursing education is essential for high-quality care.

Humans

Organizational bullying among nursing faculty: A systematic review of consequences, contributing factors, and interventions.

BACKGROUND: Organizational bullying among nursing faculty is a systemic and pervasive issue with profound psychological, professional, and institutional consequences. Despite increasing awareness, the literature remains fragmented, and a comprehensive synthesis is lacking. METHODS: This systematic review followed PRISMA guidelines and examined empirical studies on organizational bullying among nursing faculty, with no date restrictions applied. A structured search across five databases (PubMed, Scopus, Web of Science, CINAHL, and Embase) identified studies that met inclusion criteria related to the consequences, contributing factors, and interventions. The Mixed Methods Appraisal Tool (MMAT) was used to assess study quality. RESULTS: Fifteen studies meeting the quality threshold were included. Organizational bullying was consistently associated with psychological distress (e.g., anxiety, depression, burnout, suicidal ideation), professional disengagement, and intent to leave. Contributing factors were categorized into structural and organizational (e.g., hierarchical power imbalances, toxic workplace culture), managerial and HR-related (e.g., lack of leadership support, poor reporting mechanisms), and individual/social (e.g., gender or ethnic discrimination, early-career vulnerability). Intervention strategies identified included policy reforms, leadership training, supportive reporting systems, and psychological support services, though evidence on their effectiveness remains limited. CONCLUSIONS: Organizational bullying in nursing academia is a serious and multifaceted challenge with detrimental effects on individuals and institutions. Addressing it requires a comprehensive, evidence-based approach that includes structural reforms, leadership development, and psychosocial support systems. Academic institutions must prioritize the creation of safe, inclusive, and respectful environments to retain faculty and sustain the quality of nursing education.

Faculty, Nursing

Educational Effects of Electronic Documents and Videos on Parents' Responses to Acute Illness in Young Children: A Randomized Controlled Trial.

AIM: This study compared changes associated with electronic document-based and video-based education for parents responding to acute illness in young children, focusing on self-reported knowledge, anxiety, and satisfaction. METHODS: A randomized controlled trial with pre- and post-intervention measurements was conducted among 140 adults in Japan who self-reported raising a child under 3&#x2009;years of age and having experienced their child's acute illness. Participants were assigned to an electronic document group or a video group (n&#x2009;=&#x2009;70 each). Self-reported knowledge was assessed using a researcher-developed questionnaire, and anxiety was measured using the State-Trait Anxiety Inventory. Pre-post changes and between-group differences in change scores were examined. RESULTS: Total self-reported knowledge scores increased significantly in both groups (p&#x2009;<&#x2009;0.01), with no significant between-group difference. The video group showed significant improvements in items related to symptoms requiring attention at home and information sources, whereas the electronic document group improved in items related to symptoms requiring medical consultation and emergency calls. State and trait anxiety did not change significantly in either group. Satisfaction was high in both groups. CONCLUSIONS: Both educational formats may support parents' learning about responses to acute illness in young children, although appropriate formats may differ according to the educational content. Information provision alone may have limited effects on anxiety; therefore, future parent education should incorporate interactive and reassurance-focused approaches. TRIAL REGISTRATION: UMIN-CTR: UMIN000056457.

Humans

How AI-supported intelligent systems support infection prevention and control training in healthcare: A systematic review of educational functions and outcomes.

AIMS: Artificial intelligence (AI)-supported intelligent systems have been increasingly incorporated into infection prevention and control (IPC) education and training, primarily to support the monitoring of observable behaviors and the provision of feedback. However, existing evidence has focused largely on short-term compliance outcomes, with limited synthesis of the educational role of AI-supported intelligent systems in supporting sustained IPC competence. This systematic review examined how AI-supported intelligent systems have been designed and used to support IPC education and training, with a focus on system characteristics, educational functions, and reported outcomes. DESIGN: A systematic literature search was conducted across the PubMed/MEDLINE, Embase, Cochrane, and CINAHL databases. DATA SOURCES: A total of 18 studies met the inclusion criteria. Findings were qualitatively synthesized according to system design characteristics, educational functions, and outcome domains. REVIEW METHODS: Methodological quality was appraised using the Mixed Methods Appraisal Tool. RESULTS: Most AI-supported intelligent systems focused on hand hygiene and relied on fully automated monitoring systems to capture behaviors and provide performance feedback. Educational functions were predominantly limited to performance assessment, automated feedback, and reminders. Outcomes were mainly measured using compliance or performance metrics, whereas sustained behavioral change and decision quality were rarely assessed. CONCLUSIONS: AI-supported intelligent systems have been used primarily to reinforce short-term IPC performance and compliance. However, their current applications for supporting sustained competence over time remain limited. The findings of this review suggest that AI-supported intelligent systems may serve as maintenance-oriented educational support by extending learning beyond initial instruction through repeated practice and feedback. Future research should prioritize outcome measures that capture the durability of performance and decision-making processes to better align AI-supported intelligent systems used in IPC education and training with the educational demands of clinical practice.

Humans

The impact of artificial intelligence on critical thinking and clinical reasoning in health professions education: A systematic review and meta-analysis.

BACKGROUND: Critical thinking and clinical reasoning underpin healthcare professionals' ability to navigate uncertainties and deliver safe and effective care. With artificial intelligence (AI) advancement and growing adoption, AI-based educational tools are increasingly used to support these cognitive competencies' development. OBJECTIVE: To synthesize randomised and controlled clinical trials on AI-based educational tools in health professions education and examine their effects on critical thinking and clinical reasoning among health professions students. METHODS: Six electronic databases were searched from January 1, 2014 to July 28, 2025 was reviewed: PubMed, Cochrane Central Register of Controlled Trials, CINAHL, Scopus, Embase and Web of Science. Two independent reviewers performed data extraction and quality assessment using standardized JBI checklists. The GRADE approach was used to assess the certainty of evidence. Studies were pooled via random-effects meta-analyses or narrative syntheses. RESULTS: Fourteen randomised controlled trials and seven controlled clinical trials were included (n&#xa0;=&#xa0;21). Meta-analyses revealed small to medium effect sizes for the surrogate clinical reasoning outcomes of performance-based assessment scores (SMD 0.68; 95% CI [0.38, 0.98], p-value&#xa0;=&#xa0;0.00; I2&#xa0;=&#xa0;38%) and knowledge test scores (SMD 0.39; 95% CI [0.09, 0.69], p-value&#xa0;=&#xa0;0.01; I2&#xa0;=&#xa0;79%). Critical thinking and clinical reasoning skills and dispositions were narratively synthesized, with majority of included studies favouring AI-based interventions but the evidence had low to very low certainty. CONCLUSION: AI-based educational interventions may improve critical thinking and clinical reasoning among health profession students, but the evidence is very uncertain. This review offers preliminary insights but does not allow identification of optimal interventions or discipline-specific recommendations due to small sample sizes and substantial intervention heterogeneity. Further research is required to draw definitive conclusions. PROTOCOL REGISTRATION: CRD42025634074.

Humans

Attitudes, knowledge, and behavioral control regarding child abuse reporting in middle eastern nursing professionals: A systematic review and meta-analysis.

INTRODUCTION: Child abuse is critically underreported in the Middle East, with up to 90% of cases going unidentified. Nurses play a central role in child protection systems, yet factors influencing their reporting practices in this region have not been comprehensively synthesized. This study aims to review systematically and meta-analyze evidence on Middle Eastern nurses' knowledge, attitudes, and perceived behavioral control regarding child abuse reporting. METHODS: We conducted a systematic review and meta-analysis following PRISMA guidelines. Five databases (PubMed, Scopus, Web of Science, Embase, Cochrane Library) were searched through November 2025. Studies targeting nursing professionals or students in Middle Eastern countries assessing knowledge, attitudes, intention to report, subjective norms, or perceived behavioral control were included. Random-effects meta-analyses were performed with subgroup analyses comparing students and practicing nurses. RESULTS: Fourteen studies comprising 4018 participants across six countries met the inclusion criteria. The pooled knowledge score was 61.64% (95% CI: 50.14-73.14), with nursing students scoring higher than practicing nurses (75.28% vs. 54.79%, p&#xa0;=&#xa0;0.03). The pooled attitude score was 60.69% (95% CI: 44.82-76.57). Educational interventions significantly improved knowledge (SMD&#xa0;=&#xa0;1.54, 95% CI: 0.70-2.38, p&#xa0;=&#xa0;0.0003). The pooled proportion of nurses intending to report suspected abuse was 75% (95% CI: 0.58-0.92). The pooled subjective norm score was 8.02 (95% CI: 7.75-8.29), and the pooled perceived behavioral control score was 24.34 (95% CI: 22.20-26.46). High heterogeneity (I2&#xa0;>&#xa0;95%) reflects substantial variability in educational and legal contexts across the region. CONCLUSIONS: Middle Eastern nurses show moderate knowledge and attitudes toward child abuse reporting, with notable gaps among practicing professionals. Educational interventions are effective but should be integrated with systemic reforms, including mandatory reporting legislation and clear protocols.

Humans

Female genital mutilation knowledge, attitudes and training needs among health professionals in non-practicing countries: A literature review.

BACKGROUND: With increasing globalization and migration, the number of women affected by female genital mutilation who reside in countries where the practice is not traditionally performed is constantly increasing. Healthcare providers in these settings are required to address the complex health needs of this vulnerable population. We aimed to synthesize recent literature on their knowledge, preparedness, and educational background. METHODS: We conducted a systematic review across PubMed, Scopus and Embase, identifying papers published from January 2015 onwards, examining providers' knowledge, education and attitudes toward female genital mutilation in non-practicing countries. Both quantitative and qualitative observational studies were eligible. Given heterogeneity in study populations, outcome definitions, and assessment tools, findings were synthesized narratively. The review protocol was registered with the International Prospective Register of Systematic Reviews (CRD420251044761). FINDINGS: 1046 records were screened by title and abstract, and 140 full-text articles were assessed for eligibility. 31 studies met the inclusion criteria (23 quantitative, 8 qualitative). Many providers reported clinical experience with women affected by female genital mutilation, yet substantial variability was observed in knowledge, training, and attitudes. Gaps were particularly evident regarding legislation, World Health Organization classification, clinical guidelines, referral pathways, workplace protocols. Midwives and younger professionals tended to demonstrate higher knowledge levels. Training exposure ranged from 5% to 91%, and many participants perceived it as insufficient. Qualitative findings echoed these patterns, highlighting challenges in female genital mutilation classification, legal awareness, documentation systems, the impact of providers' cultural beliefs on care delivery. CONCLUSION: Considerable efforts are needed to equip healthcare providers to deliver high-quality, culturally competent care to women affected by female genital mutilation. Research should develop validated tools to assess preparedness, adopt mixed-methods strategies to capture patient and provider perspectives, and guide standardized, up-to-date training programs, strengthening knowledge in managing female genital mutilation.

Humans

Multicenter randomized effectiveness/implementation trial of a digital self-management support tool to improve the quality of life during adjuvant hormonal therapy for patients with early breast cancer: The HOPE trial.

BACKGROUND: For patients with hormone receptor (HR) positive early breast cancer (BC), adjuvant endocrine therapy (ET) represents the cornerstone of treatment. However, 75% of patients experience ET-related symptoms that negatively affect their quality of life (QOL). Despite their high prevalence, these symptoms are often underestimated and under-addressed during consultations. As a result, non-adherence to ET is common and remains a major barrier for optimal disease and survival outcomes. METHODS: National, prospective, randomized, open-label hybrid type 1 effectiveness/implementation trial conducted in France comparing a personalized digital health pathway plus standard of care (SoC) vs. SoC alone in patients with HR+ early BC reporting ET-related symptoms. 180 patients will be randomized 1:1 to receive either 12&#xa0;weeks of the digital health pathway or 12&#xa0;weeks of SoC. The intervention is anchored by the Resilience&#xa9; digital companion including remote symptom and needs assessment, an introductory nurse-navigator phone call, and access to personalized, symptom-specific online educational and self-management programs (physical activity, yoga, meditation or cognitive behavioral therapy). In both arms, patients will be invited to wear a wearable device to objectively monitor behavioral parameters. The primary endpoint is the ET symptoms scale of the European Organization for Research and Treatment of Cancer (EORTC) QLQ-BR45 over 12-weeks. Secondary endpoints include other QOL domains, self-reported ET adherence, eHealth literacy, self-efficacy, and evaluation of the implementation process. DISCUSSION: This study should provide evidence on the effectiveness and real-world implementation of a personalized digital health pathway to improve QOL in patients experiencing ET-related symptoms. TRIAL REGISTRATION: ClinicalTrials.gov NCT06781996; Protocol version 3.0.

Humans

Global prevalence and associated factors of turnover intention among intensive care nurses: A systematic review and meta-analysis.

OBJECTIVES: To estimate the global prevalence of two distinct turnover intentions among intensive care unit (ICU) nurses-intention to leave the ICU and intention to leave the nursing profession-identify significant sources of heterogeneity, and synthesise associated psychosocial factors. METHODS: Ten databases were systematically searched from inception to September 28, 2025. Two reviewers independently conducted study selection, data extraction, and quality appraisal using Joanna Briggs Institute checklists. Random-effects meta-analyses were performed to estimate pooled prevalence and associated factors. Subgroup and meta-regression analyses explored potential sources of heterogeneity. Associated factors were pooled as odds ratios (ORs) and interpreted within an integrated Job Demands-Resources and Theory of Planned Behavior framework. RESULTS: Forty-six studies published between 2007 and 2025, involving 39,246 ICU nurses, were included. The pooled prevalence was 30.7% for intention to leave the ICU and 27.5% for intention to leave the nursing profession. Significant sources of heterogeneity included ICU type, geographic region, publication year, study design, measurement tool, and sampling method. Depression, burnout, high workload, and unsafe patient-to-nurse ratios were associated with increased turnover intention, whereas positive work environments, perceived organisational support, and nursing competence were protective factors. No significant publication bias was detected. CONCLUSIONS: Turnover intention affects approximately one-third of ICU nurses globally and varies across clinical and geographical contexts. Excessive workload, inadequate organisational support, and unfavourable work environments appear to be important contributors to turnover intention among ICU nurses. IMPLICATIONS FOR CLINICAL PRACTICE: Strategies to reduce turnover intention among ICU nurses should focus on reducing excessive workload, improving staffing conditions, strengthening organisational support, and fostering positive work environments. Promoting supportive and sustainable ICU work environments may help improve nurse retention and maintain the quality of critical care services.

Humans

Investing in Canada's nursing workforce: a comprehensive review to inform policy innovations and directions.

BACKGROUND: Health systems worldwide face persistent health workers challenges including nursing shortages, workforce strain, and inequities. In Canada, these challenges have prompted renewed national and provincial reforms to strengthen recruitment, retention, leadership, and sustainability. This paper compares nursing workforce policy directions across Canada, and international jurisdictions to inform policy and planning. METHODS: A cross-country comparative analysis of policies building on a comprehensive national funded review that included an umbrella review of 69 systematic reviews, a comparative policy review of nursing workforce strategies in five jurisdictions, and validation through national horizon-scanning and policy dialogues (n >100). Evidence was analyzed across system, organizational, and individual levels. RESULTS: At the system level, international jurisdictions demonstrate comprehensive, legislated approaches integrating data, governance, and multi-year funding have advanced key nursing strategies. In Canada, the advances show the importance of strategies to have national and provincial/territorial alignment emphasizing leadership, flexibility, and inclusion as key levers. Organizational and individual-level reforms such as mentorship, leadership development, and wellness initiatives are expanding but remain variably evaluated. Experts identified national workforce data strategies and policy integration with embedded evaluation as key enablers to inform scalability and sustainability of implemented strategies. CONCLUSIONS: Canada's nursing workforce reforms are advancing toward coordinated, equity-driven, and evidence-informed strategies. Continued investment in evaluation, leadership, and national integrated data systems along with integrating nursing workforce planning within broader intersectoral planning will consolidate these gains and position Canada as an international leader in sustainable nursing workforce policy.

Canada

Exploring the perceptions, experiences, and behaviours that nurses and midwives face in relation to sleep: A systematic review of qualitative evidence.

BACKGROUND: The importance of sleep for nurses and midwives is increasingly being recognised. Poor sleep is known to have negative impacts on physical health, mental wellbeing, and work performance. This has prompted efforts to promote and support staff sleep. However, further efforts are needed to understand how nurses and midwives consider and manage sleep to ensure that meaningful and effective interventions are adopted and sustained. AIMS: This review of qualitative evidence aims to examine nurses' and midwives' perceptions, experiences, and behaviours around sleep. METHODS: This review followed JBI's systematic meta-aggregative approach including development of an a priori protocol. A systematic search of six electronic databases (MEDLINE, Embase, Emcare, PsycINFO, CINAHL, and Scopus) was undertaken to identify qualitative studies that examine nurses' and midwives' perceptions, experiences, and behaviours related to sleep. The search was conducted on the 10th of October 2024. Study selection, quality appraisal, data extraction, and synthesis followed JBI approaches and the ConQual approach was used to report assessment of synthesised findings. RESULTS: Thirty-three studies were included for review, and 245 findings were aggregated into 24 categories and nine synthesised findings related to the perceptions, behaviours, and experiences. While sleep was perceived as important, poor sleep was often understood as an expected and inevitable part of the job and that there was a need to always be awake to provide continual care. Experiences influencing sleep related to personal circumstances and work-related factors, as well as professional training and institutional practices. A range of behaviours, including planning time to sleep, using sleep aids, modifying the sleep environment, and altering daytime behaviours were also described. CONCLUSION: This review identified a range of perceptions, behaviours, and experiences that may influence the sleep of nurses and midwives which are vital to supporting individual and workforce wellbeing and safe, effective clinical practice. Insights from this review can be used to better understand nurses' and midwives' relationship with sleep and to develop and enhance targeted sleep interventions and programs that aim to promote and support healthy sleep among nurses and midwives. Open Science Framework Registration: 10.17605/OSF.IO/F32UM.

Humans