The letter centers around a recent study published in the Nursing Practice Today, titled “Medication errors occurrence and reporting: A qualitative study of the Jordanian nurses” (1), which sheds light on the experiences of Jordanian nurses regarding medication error incidence and factors that may influence their decisions to report or not. The study deserves praise for its insightful look at the critical issues of medication errors. Most importantly, this study calls for serious reflection on one’s moral duty in error reporting. Following this call, this commentary will be set on the fiduciary duty of the individual nurse and organization.   

Patient safety incidents have emerged as a significant global concern, impacting healthcare systems worldwide, as highlighted by the WHO's report of 134 million adverse events annually in hospitals. Healthcare professionals often hesitate to report such incidents due to stigma and the fear of criticism. To combat this, the implementation of a "no-blame culture," introduced by James Reason in 1997, has gained traction, evolving into the concept of a just culture—an environment fostering open discussion of safety-related information without fear of retribution. This approach facilitates an effective incident reporting system and enhances staff capabilities while building organizational trust and accountability. Previous research indicates that adopting a just culture can lead to increased reporting of patient safety incidents, enabling healthcare staff to learn from them, thus reducing the likelihood of future incidents. It’s critical to recognize that a just culture focuses on systemic issues rather than individual blame, which encourages reporting and corrective action. However, this culture is not yet widespread due to misunderstandings. Healthcare leaders and policymakers are urged to promote a just culture by implementing strategies like transparent reporting mechanisms, clear error identification processes, exemplary leadership, and ongoing assessments, ultimately prioritizing patient safety.

Background & Aim: Transgender women represent a vulnerable population with a high rate of depression. This systematic review aims to identify and analyze the factors associated with depression in this population.
Methods & Materials: The research protocol was registered with PROSPERO. A systematic search was conducted using PubMed, MEDLINE, Scopus, and ProQuest for studies published between 2014 and 2024. Relevant studies focusing on depression and related factors in transgender women were selected. Data extraction focused on identified factors associated with depression. The reporting of this review adhered to PRISMA guidelines, and the quality of included studies was appraised using JBI’s critical appraisal tools. A narrative synthesis was conducted to synthesize the findings.
Results: From 2,511 records identified in the database, 14 cross-sectional studies were included in the review. The analysis revealed three primary categories of factors related to depression: demographic, psychological, and sociological factors. Key demographic factors included age and insufficient income, both of which were at increased risk of depression. Psychological factors such as self-stigma and self-esteem were associated with higher depression rates. Sociological factors, including family support, peer support, and violence, were also significant predictors of depression in transgender women.
Conclusion: Depression in transgender women is influenced by a complex interaction of demographic, psychological, and sociological factors. These findings underscore the need for tailored nursing interventions that incorporate mental health support.

Background & Aim: Globally and in Indonesia, the number of people with breast cancer is still rising, and one of the most commonly reported symptoms is pain. After hospitalization, patients continue their lives at home, and most receive care in an outpatient setting. In this setting, they voluntarily need to be able to manage their pain. Therefore, teaching and assisting patients in self-management is essential for adequate pain management. This study aims to determine the effect of pro-self-pain control and guided imagery interventions on reducing pain intensity in outpatient breast cancer.
Methods & Materials: A quasi-experimental design, using convenience sampling on 49 patients, and allocated into an intervention group (n=25) that received pro-self-pain control and guided imagery intervention and a control group as a comparison (n=24) that received pro-self-pain control only. Pain intensity in both groups was measured before the experiment and ten days after using the Numeric Rating Scale.
Results: The results showed that there was a significant decrease in pain intensity in the intervention group p<0.001. The control group also experienced a decrease in pain intensity, but not significant p=0.212. Before the intervention, both groups showed no significant difference (p=0.872). However, after the intervention, the difference test between the two groups showed a significant difference with a p=0.004 and a small effect size (d=0.40).
Conclusion: The combination intervention of Pro-self-pain control and guided imagery (with audio recordings) effectively reduces pain intensity, although the effect size produced tends to be small. In caring for cancer patients, it is recommended to improve health education regarding pain management, thereby enabling them to self-manage their pain and participate actively in controlling it.

Background & Aim: Falls among hospitalized patients pose severe consequences, necessitating accurate risk prediction. Traditional assessment tools rely on cross-sectional data and lack dynamic analysis, limiting clinical applicability. This study developed an AI-based fall risk prediction model using supervised learning techniques to enhance predictive accuracy and clinical integration.
Methods & Materials: This study was conducted at a medical center in Taiwan, excluding pediatric patients due to non-disease-related fall factors. Fall cases were obtained from hospital records, and non-fall cases were stratified based on age and gender to create a balanced 1:1 dataset.
A total of 52 predictive variables were identified and refined to 39 through expert review. The AI model was compared with MORSE, STRATIFY, and HII-FRM using supervised learning with 10-fold cross-validation. Performance was evaluated based on accuracy, sensitivity, and specificity.
Results: The results demonstrated that the AI-based model significantly outperformed traditional fall risk assessment tools in accuracy, sensitivity, and specificity. More importantly, the model’s superior predictive power allows for real-time risk assessment and seamless integration into clinical decision support systems. This integration can enable timely interventions, optimize patient safety protocols, and ultimately reduce fall-related incidents in hospitalized settings.
Conclusion: By automating risk assessment, the AI model can alleviate the workload of healthcare professionals, reducing the time required for manual evaluations and minimizing subjective biases in clinical decision-making. This not only enhances operational efficiency but also allows nursing staff to allocate more time to direct patient care. These findings underscore the transformative potential of AI-driven approaches in healthcare, improving patient safety through data-driven.

Background & Aim: Missed care is a serious problem in healthcare. This study aimed to measure the prevalence of missed nursing care and determine the reasons and risk factors for its occurrence in surgical and medical departments.
Methods & Materials: A cross-sectional design was used. All registered nurses who had worked for more than six months were included. The MISSEDCARE survey tool was used to determine missed nursing care (Part A) and the reasons for its occurrence (Part B). Logistic regression was used to determine risk factors for missed nursing care. The significance level was set at p<0.05.
Results: A total of 165 nurses were included. The response rate was 81.2%. The prevalence of missing nursing care ranged from 4.8% to 84.8%. Nurses with a high turnover intention had a great risk of the following missed nursing care: ‘medications administered within 30 min before or after the scheduled time’ [OR=11.60, CI 95%: 3.76-35.75; p<0.0001], ‘assess the effectiveness of medications’ [OR=3.79, CI 95%: 1.79-8.04; p<0.0001]. Urgent patient situations were the main reasons for missing patient-specific reassessment to verify improvement or deterioration during the shift [OR=6.82, CI 95%:1.84-25.26; p =0.008] and assess the effectiveness of medications.
Conclusions: This study showed a high prevalence of missed nursing care in surgical and medical departments. Urgent patient situations and unexpected increases in patient volume and acuity in the unit increased the reasons for missed nursing care. Nursing managers can promote the adoption of care models such as Primary nursing to reduce and manage missed nursing care.

Background and Aim: Non-Communicable Diseases (NCDs) remain a global challenge. The primary healthcare has been identified as a vital aspect of the healthcare system that will assist in addressing the burden of NCDs in low and middle-income countries. As such, the Eswatini Ministry of Health-NCD program had embarked on the decentralization of NCDs` services to primary healthcare facilities. This initiative called for nurses to deliver NCD treatment services in primary healthcare facilities. However, the experiences of community nurses about this initiative have not been explored. Therefore, this study explored and described the community nurses` experiences with decentralizing care for NCDs in the Lubombo Region of Eswatini.
Methods and Materials: A descriptive qualitative study design approach was used to explore and describe the experiences of ten purposively sampled community nurses. Data was collected through audio-recorded face-to-face interviews using a semi-structured interview guide. Data was subjected to thematic analysis using Colaizzi’s descriptive method of data analysis.
Results:  Three themes emerged from the study findings; 1) Decentralising NCD care is a good move by the Government, 2) Challenges brought by the decentralization of NCD services, and 3) Nurses’ perceived support needs in managing NCDs at clinics.
Conclusion: Community nurses applauded the government`s move to decentralized NCD services even though they viewed rural clinics as not well prepared to offer NCD services due to the challenges faced. There is a need for more support for rural clinics regarding human resources, NCD diagnostic equipment and medicines, and training of nursing personnel.

Background & Aim: Given the high turnover rate among nursing staff, contemporary healthcare facilities are experiencing an increasing demand for nurses. Retaining nursing personnel is crucial for ensuring patient safety and preventing malpractice. Job embeddedness has emerged as a key determinant in employee retention. This study examined the relationship between job embeddedness and nurses' turnover intentions.
Methods & Materials: This descriptive-analytic study included 242 nurses from hospitals affiliated with Zahedan University of Medical Sciences, Iran. Participants were selected through stratified random sampling. Data were collected using a demographic questionnaire, the Global Job Embeddedness Scale, and a turnover intention questionnaire. The data were analyzed using independent t-tests, Pearson correlation coefficients, and ANOVA.
Results: The mean turnover intention score was relatively high, particularly in the organizational (M±SD= 3.3±0.7) and professional (M±SD= 3±0.8) dimensions. The mean score for job embeddedness was above average (M±SD= 2.8±0.9). The Pearson correlation coefficient analysis revealed a significant negative correlation between job embeddedness and turnover intentions among nurses (r= -0.3, p<0.001).
Conclusion: The study concluded that higher levels of job embeddedness are associated with a lower intention to leave the profession. By enhancing and maintaining job embeddedness among nurses, it is possible to reduce turnover rates, ultimately contributing to improved patient care.

Background & Aim: Noncommunicable diseases (NCDs) are the leading cause of morbidity and mortality worldwide, heavily impacting low and middle-income countries like Indonesia. Community Health Centers (CHCs) play a critical role in providing healthcare, including NCD management, but they face significant challenges. This study explores the challenges and barriers to NCD management at CHCs in South Sumatra Province, Indonesia.
Methods & Materials: To gain an in-depth understanding of healthcare workers’ management of NCDs, an exploratory content analysis approach was employed. Data were collected through semi-structured interviews with 12 health workers, including nurses, doctors, midwives, and public health workers. Content analysis was used for data analysis.
Results: The content analysis identified five themes: Resource constraints in primary healthcare, lack of effective interprofessional collaboration, social and cultural issues; work area coverage, and government policy and support.
Conclusion: These findings highlight the complex challenges faced by CHCs. Addressing them requires a comprehensive strategy to enhance NCD care and primary healthcare services. Policymakers and health system managers can use these insights to develop targeted interventions. Further research is recommended to assess the effectiveness of specific strategies in overcoming these barriers in low-resource settings.

Background & Aim: The pain of needle insertion in arteriovenous fistula, fatigue, and sleep disturbances are common problems in hemodialysis patients. Using lavender products can help reduce these problems. This study aimed to compare the effects of lavender aromatherapy and lavender tea consumption on reducing pain and fatigue, as well as improving sleep quality in hemodialysis patients.
Methods & Materials: This study is an open-label trial conducted at the Dialysis Center at Tabriz University of Medical Science from May to December 2022. Random allocation was done by randomizing the moved blocks. hemodialysis patients were allocated to one of the three study groups: control (n=30), lavender inhalation (n=30), and lavender tea (n=30). At the baseline and the end of the study, Participants' sleep quality with PSQI, fatigue with FSS, and pain of needle insertion in arteriovenous fistula with Vas scale were assessed. The data analysis was performed using SPSS software The Analysis of covariance (ANCOVA) test was used to compare the mean of variables between the study groups.
Results: A comparison of the follow-up scores between 3 groups shows that participants in the lavender tea group and lavender aromatherapy group had a lower score of total score of PSQI (P<0.001), fatigue (P<0.001), and pain(P<0.001) following the intervention compared to the control group. Also, there was no statistically significant difference between the lavender tea group and the lavender aromatherapy group in terms of sleep quality scores (P=0.428), fatigue (P=0.570), and pain (P=0.997).
Conclusion: The findings of this study showed that lavender can be useful in improving the problems of dialysis patients, such as sleep quality, fatigue, and pain caused by needle insertion.

Objective

This study aims to develop a wearable arm measurement device and mobile application for the prevention and early detection of lymphoedema and evaluation of their efficacy.

Methods

This is a two-phase mixed method study including two qualitative study, reproducibility study, and a pilot randomized controlled trial. The first phase is the development of the arm volume measuring device and mobile application, and the second phase is the evaluation of the effectiveness of the products. The mobile application will consist of five sections focusing on the prevention and early detection of breast cancer-related lymphedema: (I) exercise, (II) education, (III) coping mechanisms, (IV) arm volume measurement/recording, and (V) reminder for exercise, measurement, and follow-up. Exercise videos and educational content will be developed based on the current guidelines and revised according to expert opinion. A qualitative design will identify patients' problems and coping mechanisms related to lymphedema. The arm volume measurement device will be developed using stretch sensors. In evaluating the effectiveness of the products, a pilot RCT, a reproducibility study, and patient feedback will be used as a basis. This study was supported by the Scientific and Technological Research Council of Türkiye (TUBITAK) (Grant Number 223S524).

Conclusion

This study will contribute to the wellbeing of cancer survivors by enabling the prevention and early detection of lymphedema, and to the healthcare professionals by enabling the regular follow-up of limb volume without the necessity of a hospital visit.

Background: Emergency department nurses experience unique stressors that contribute to elevated levels of occupational stress. Most existing instruments assess general occupational stress without addressing workplace-specific factors. This study aims to evaluate the psychometric properties of the Farsi version of the Stressor Scale for Emergency Nurses (F-SSEN).

Methods: Face and content validity were assessed by five clinical nurses and five nursing experts, respectively. Construct validity, known group validity, and convergent validity were tested on 198 emergency nurses. The test-retest reliability was evaluated in 21 nurses over a two-week interval. Internal consistency was measured using Cronbach's alpha and McDonald's omega coefficients.

Results: Face and content validity were found to be satisfactory. Exploratory factor analysis (EFA) identified four factors—conflicts, life and death situations, patients' families' actions and reactions, and technical and formal supports—which explained 60.64% of the total variance. Convergent validity showed a correlation of 0.554 between job stress scores based on SSEN and Brief Nursing Stress Scale (BNSS). Known group validity revealed that occupational stress scores were higher in women than in men, and there was a significant negative correlation between occupational stress scores and work experience in the emergency department. Cronbach's alpha and McDonald's omega coefficients were 0.953 and 0.954, respectively, and the intraclass correlation coefficient was 0.943.

Conclusions: The Farsi version of the stressor scale for emergency nurses demonstrates strong psychometric properties, making it reliable for measuring occupational stress in emergency nurses.