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Background & Aim: Delirium is a common, serious postoperative complication in cardiac surgery. This study evaluated the impact of nurse-implemented multimodal nonpharmacologic bundles on delirium incidence and severity in adult cardiac surgery ICU patients.
Methods & Materials: A systematic review and meta-analysis were conducted. A systematic literature search was performed across PubMed, Scopus, ScienceDirect, and Cochrane Library from inception to September 15, 2025. Data from eligible studies were extracted for narrative synthesis and meta-analysis. Pooled Odds_Ratios and 95% Confidence Intervals were calculated to evaluate delirium incidence, and statistical heterogeneity was assessed using the I² statistic.
Results: Thirteen studies were included, with eight studies (N=3,831) suitable for meta-analysis. Nurse-implemented bundles were associated with a reduced incidence of delirium (OR 0.56; 95% CI: 0.41–0.75; I2=14%). Narrative synthesis of five additional studies indicated that interventions such as early mobilization and sensory-based bundles (eye masks/earplugs) may mitigate delirium severity. Furthermore, physical frailty was identified as a significant risk factor (Adj. OR 1.61), and Scenario-Based Learning was found to be a viable approach for enhancing nurse competency.
Conclusion: Nurse-implemented multimodal non-pharmacological bundles contribute to reducing delirium incidence in cardiac surgery ICUs. These findings suggest that such protocols serve as a relevant secondary prevention strategy. However, given the diversity of intervention components and geographical settings, these results should be interpreted with caution. Clinical protocols should consider integrating frailty screening and environmental modifications, while future research should prioritize standardized continuous outcomes like Delirium-Free Days.

Background & Aim: Guided imagery is a mind–body intervention increasingly explored in oncology supportive care, particularly among breast cancer patients. Published studies vary in terms of intervention characteristics, delivery methods, and outcome measures. This scoping review aimed to map the existing literature on guided imagery interventions in breast cancer populations, describe intervention characteristics and reported outcomes, and identify gaps to inform future research directions.
Methods & Materials: A scoping review was conducted in accordance with PRISMA-ScR guidelines. Five electronic databases were systematically searched for studies published between 2016 and 2025 that evaluated guided imagery interventions in breast cancer or broader oncology populations. Eligible studies included randomized controlled trials, quasi-experimental studies, and mixed-methods research. Data were synthesized narratively with a focus on intervention characteristics, delivery modalities, reported outcomes, and standardization-related issues.
Results: Twenty-three studies were included. The review identified substantial heterogeneity in intervention characteristics, including session duration, frequency, delivery modality, and combination with other techniques. Frequently assessed outcomes included anxiety, depression, pain, fatigue, and quality of life. Variability in intervention protocols and outcome measures limited cross-study comparability.
Conclusion: The literature reveals considerable heterogeneity in guided imagery interventions and outcome measurement in breast cancer care. This variability highlights the need for clearer intervention reporting and greater consistency in outcome measurement to support future rigorous effectiveness research.

Background & Aim: Patients undergoing cardiac catheterization commonly experience elevated anxiety, illness uncertainty, and self-care challenges. This study evaluated the effectiveness of an integrated nursing program on anxiety, uncertainty in illness, and self-care ability among patients undergoing first-time cardiac catheterization.
Methods & Materials: A quasi-experimental study with repeated measures was conducted among 60 middle-aged adults (40–65 years) scheduled for first-time cardiac catheterization at a tertiary hospital in Bangkok, Thailand. Participants were consecutively enrolled and allocated using systematic alternating assignment (intervention n=30; control n=30). The intervention comprised a four-phase integrated nursing program based on Mishel's Uncertainty Theory and Orem's Self-Care Theory. Primary outcomes were measured using STAI, MUIS-A, and SCHFI at four time points.
Results: Baseline characteristics revealed no significant differences between groups (p>0.05). Mixed ANOVA revealed significant Group × Time interaction effects for all primary outcomes: anxiety [F(3,174)=39.796, p<.001, ηp²=0.407], uncertainty in illness [F(3,174)=13.827, p<.001, ηp²=0.193], and self-care ability [F(3,174)=4.485, p=.005, ηp²=0.072]. The intervention group demonstrated progressive reductions in anxiety and uncertainty in illness alongside sustained improvements in self-care ability. The intervention group experienced fewer complications (3.3% vs. 20.0%, p=0.044) and higher satisfaction scores (142.8±6.2 vs. 118.5±8.7, p<0.001).
Conclusion: The integrated nursing program effectively reduced anxiety and uncertainty while enhancing self-care ability among cardiac catheterization patients, demonstrating clinical utility for improving perioperative outcomes.
Trial Registration: Thai Clinical Trials Registry (Registration pending - Request No. TCTR 20260210)

Background & Aim: Advanced Practice Nursing plays a crucial role in improving healthcare access, quality, and efficiency, being increasingly recognized in Portugal as a growing professional field. However, no validated instrument exists in Portugal to rigorously assess advanced practice nursing competencies. The Advanced Practice Nursing Competency Assessment Instrument, originally developed and validated in Spain, represents a robust tool for this purpose. This study aimed to cross-culturally adapt and validate the Advanced Practice Nursing Competency Assessment Instrument for the Portuguese context.
Methods & Materials: This methodological study was conducted in two phases. Cross-cultural adaptation followed established stages: two independent forward translations, synthesis, two back-translations, expert committee review, pre-test, and feedback to the original author. Psychometric evaluation used a cross-sectional sample of nurses from a local health unit in Northern Portugal. Analyses included descriptive statistics, exploratory factor analysis through principal component analysis, and internal consistency calculated by Cronbach’s alpha, item–total, and inter-item correlations.
Results: Expert consensus was achieved during the review process. The pre-test with a sample size of thirty-five nurses confirmed instrument clarity and usability. The validation sample included two hundred and sixty-four nurses and specialist nurses. Seven factors explained sixty-six percent of the total variance, representing a reduction from the original eight-factor structure. Two dimensions, Quality Management and Care Management, converged into a single factor in the Portuguese version. The scale demonstrated excellent reliability, with a total Cronbach’s alpha of 0.960, factor alphas ranging from 0.821 to 0.916, and adequate corrected item–total correlations.
Conclusion: The Portuguese version demonstrates adequate content validity, a coherent factor structure, and excellent reliability, supporting its use to assess advanced practice nursing competencies in the Portuguese health system.

Background & Aim: Long working hours and job demands in intensive care units can compromise family quality time for nurses, leading to burnout, higher turnover, and safety risks. Conversely, nurses who maintain meaningful family time are more likely to achieve work-life balance and job satisfaction, which enhances the quality of patient care. This study aimed to describe the meaning of family quality time for ICU nurses, identify how ICU work influences this time, and explore its impact on the care they provide. This is an important issue in the nursing field.
Methods & Materials: An interpretive description methodology was used. Using purposive sampling, 10 intensive care unit nurses from regional hospitals participated in semi-structured Zoom® interviews. Data were analyzed using thematic analysis, and strategies to support rigor included memorizing notes, an audit trail, and end-of-interview debriefing.
Results: Four themes emerged from the data of this study: Family Quality-Time: The Essential Anchor for Emotional Well-Being, Support, and Connection; Work-Related Stress: The Destructive Twister Compromising Family Time; Inadequate Family Time: The Repercussions of Exhaustion, Fatigue, and Sleep Deprivation; and The Transformative Power of Family Time on Nurses' Performance.
Conclusion: The study underscores the significance of family quality time for intensive care nurses, emphasizing its impact on their well-being and job performance. Its findings can aid nursing educators and practitioners in recognizing the necessity of fostering family connections.

Background & Aim: Gaslighting is a subtle yet harmful form of psychological manipulation, and healthcare environments are particularly vulnerable to such behaviors. Nurses are at increased risk, as gaslighting can undermine confidence, impair performance, and threaten patient safety. This study evaluated the psychometric properties of the Workplace Gaslighting Scale among Pakistani nurses.
Methods & Materials: A cross-sectional psychometric study was conducted with 217 nurses from public and private hospitals in Pakistan. Face, content, construct, convergent, and discriminant validity were assessed, and internal consistency was evaluated using Cronbach’s alpha and McDonald’s omega. Confirmatory factor analysis was used to test model structures, and known-groups validity was examined across demographic and professional subgroups. Analyses were performed using AMOS 26 and Jamovi 2.4.14.
Results: Internal consistency was high for the dimensions of Trivialization (α= 0.906; ω=0.908) and Affliction (α=0.925; ω=0.929). Convergent validity was established (AVE=0.581 and 0.713; CR = 0.905 and 0.926). Due to a very high inter-factor correlation (r=0.92), indicating a lack of discriminant validity, the dimensions were not supported as independent constructs. Instead, a second-order model demonstrated acceptable fit (CFI=0.947, IFI=0.947, CMIN/DF= 3.292), confirming they merge into a single, unified workplace gaslighting construct. Known-groups validity was indicated by higher overall scores among nurses in private hospitals compared to public hospitals (p=0.004) and a positive association with years of experience (p=0.004).
Conclusion: The Workplace Gaslighting Scale demonstrated acceptable reliability and a coherent second‑order factor structure, although certain limitations, including a high RMSEA value and lack of discriminant validity in the first‑order model, indicate that further validation with larger and more diverse samples is needed.

Background & Aim: Facebook-based online communities are widely used by nurses to seek advice, share resources, discuss employment pathways, and maintain professional connections. However, less is known about how existing Facebook groups support professional networking, shared practice, and informal continuing professional development among Filipino nurses. This study aimed to explore professional networking and shared practices among Filipino nurses in Facebook-based online communities.
Methods & Materials: A qualitative netnographic design was used. Filipino nursing-related Facebook groups were searched and screened using data-site criteria adapted from netnographic procedures, including relevance, coverage, activity, interactivity, and accessibility. Nine groups were included. Online observations were supported by Zoom interviews with 10 Filipino registered nurses and reflective field notes. From 11,134 collected posts and comments, 1,045 were selected for detailed analysis using a sequential deductive-inductive qualitative approach guided by community of practice theory and social capital theory.
Results: Facebook groups supported advice-seeking, job sharing, resource exchange, peer encouragement, milestone recognition, professional updates, and informal learning. Shared practices differed by group purpose. Domestic-focused groups centered on local employment, licensure, and workplace issues; foreign-associated groups focused on migration and overseas practice; and learning-oriented groups prioritized review materials, webinars, and professional development resources.
Conclusion: Facebook-based online nursing communities provided accessible spaces for peer-supported learning, professional connection, and informal continuing professional development. Their practical value depends on responsible use, verification of information, ethical conduct, confidentiality, and appropriate moderation.

Background & Aim: Post-discharge follow-up is essential to prevent exacerbation in patients with COPD. This study examined the impact of a 3-month nurse-led follow-up program on early symptom worsening and severe post-discharge outcomes.
Methods & Materials: A single-center, parallel-group randomized clinical trial was conducted among 88 hospitalized COPD patients in Gonabad, Iran, in 2022. The intervention group received a structured nurse-led follow-up program for three months, including planned education, telephone-based symptom monitoring, and zone-based triage with referral when needed. The control group received usual post-discharge care without scheduled follow-up. Primary outcomes were the Modified Borg Dyspnea Scale and the COPD Assessment Test at baseline and three months. Secondary outcomes included unplanned emergency department visits, readmissions, and post-discharge physical complications. Data analysis was performed in SPSS 21.0 using the Chi-square test, Fisher’s exact test, ANCOVA, and paired t-test.
Results: Modified Borg Dyspnea Scale and COPD Assessment Test scores decreased in the intervention group from 3.31 (SD=2.32) to 2.71 (SD=2.84) and 14.91 (SD=10.91) to 12.65 (SD=11.04), respectively, while they increased in control group from 4.08 (SD=2.56) to 4.43 (SD=2.72) and 16.27 (SD=11.22) to 18.36 (SD=11.70) (adjusted p=0.002 for both outcomes. Clinically meaningful improvement was more frequent in the intervention group for both Modified Borg Dyspnea Scale (p=0.013) and CAT (p=0.007). Physical complications were lower in the intervention group (25.6% vs 48.9%; p=0.024), but emergency department visits and readmissions did not differ significantly.
Conclusion: A structured nurse-led follow-up program improved symptoms and reduced complications among patients with COPD. Its integration into transitional care is recommended to enhance recovery after hospitalization.

Background & Aim: Patients undergoing long-term hemodialysis frequently experience emotional, existential, and spiritual distress that requires support beyond routine clinical care. Family caregivers are often the closest and most continuous companions throughout the treatment trajectory, yet limited evidence has examined how they experience and enact psychospiritual care in everyday hemodialysis contexts, particularly in Indonesia. This study aimed to explore family caregivers’ experiences of providing psychospiritual care to patients undergoing long-term hemodialysis.
Methods & Materials: A descriptive phenomenological study was conducted in two hemodialysis units in Indonesia. Fifteen purposively selected family caregivers of patients undergoing long-term hemodialysis participated in semi-structured in-depth interviews. Data collection continued until informational redundancy was achieved. Interview data were transcribed verbatim and analyzed using Colaizzi’s method.
Results: Three major themes were identified: (1) Enacting emotional presence as a therapeutic foundation in everyday care; (2) Facilitating spiritual meaning-making to foster inner peace and acceptance; and (3) Engaging in shared care navigation through practical support and collaborative decision-making. These findings indicate that family psychospiritual caregiving was experienced as a relational and meaning-centered process in sustaining patients’ endurance during long-term hemodialysis.
Conclusion: Family psychospiritual care in long-term hemodialysis is a sustained relational practice that integrates emotional presence, spiritual meaning-making, and shared care navigation. Hemodialysis services should recognize family caregivers as important partners in supporting patients’ emotional security, spiritual coping, treatment endurance, and gradual acceptance of illness.