Background & Aim: Nurse turnover has long been considered a serious and global issue, contributing significantly to the nursing shortage in healthcare institutions around the world. This study aimed to synthesise evidence from qualitative studies concerning nurses' perceptions of the reasons for their turnover in clinical practice.
Methods & Materials: A literature review of qualitative studies was performed according to the PRISMA statement. A systematic search of the literature was performed on five academic databases, specifically Scopus, ProQuest, PubMed, Web of Science, and OVID Nursing. The search identified 10 relevant qualitative studies published between 2013–2024. Primary studies were critically evaluated using the CASP checklist, and thematic synthesis was applied according to the method described by Thomas and Harden.
Results: Four analytical themes synthesized from twelve descriptive themes expressing nurses' experiences with their reasons for turnover were synthesized from the primary studies included in this literature review. These reasons were reflected in the following themes: Obstacles in achieving and maintaining professional role; Threatened well-being of nurses in everyday practice; Lack of teamwork and collaboration; Ineffective leadership.
Conclusion: The identified themes suggest that nurses experience a wide range of interconnected reasons influencing their decision to leave their positions. These themes highlight actionable areas for healthcare organizations, including leadership reform and burnout mitigation. Addressing these reasons requires a detailed analysis of them, setting long-term strategies at multiple levels with systemic solutions, with a clear vision of how to reduce nurse turnover. The findings of thematic synthesis suggest topics for further research in a deeper understanding of nurse turnover.

Background and Aim: Schizophrenia is a chronic mental disorder requiring continuous care. During the COVID-19 pandemic, people with schizophrenia (PLWS) faced disproportionate challenges due to healthcare disruptions. Ensuring continuity of care is essential to mitigating the burden of the disorder, and evaluating mental health outcomes helps assess the effectiveness of interventions. This systematic review examines the impact of various interventions on the mental health outcomes of PLWS during the pandemic.
Method and Materials: The protocol was registered on PROSPERO. A comprehensive search was conducted in MEDLINE, Embase, CINAHL, and ScienceDirect for studies published between 2019 and 2023. Eligible studies included experimental (randomized controlled trials and quasi-experimental studies) and non-experimental (observational) designs investigating the effects of interventions on mental health outcomes in PLWS aged 18 years and older. A narrative synthesis was used to report findings, and the quality of included studies was assessed.
Results: Of the 1,236 records screened, nine studies met the inclusion criteria, comprising five experimental and four non-experimental studies. Experimental interventions included virtual and in-person guided walking, animated audio-visual videos, animal-assisted therapy, and nutritional programs. Non-experimental interventions encompassed Metacognitive Reflection and Insight Therapy, Cognitive Behavioral Social Skills Training, vitamin D supplementation, and dietary interventions. These interventions contributed to improvements in physical activity, executive and social function, healthy behaviors, and quality of life. Additionally, positive effects were observed on anthropometric profiles, cardiovascular health, and metabolic syndrome.
Conclusion: This review highlights effective interventions that support mental health outcomes in PLWS during the COVID-19 pandemic. Integrating these approaches into routine schizophrenia care could help mitigate the pandemic’s impact and enhance long-term well-being in this vulnerable population. Further research is needed to evaluate their long-term sustainability and effectiveness.

Background & Aim: Early detection of lymphedema is crucial to prevent progression to advanced stages that impair the quality of life in breast cancer survivors. This study aims to develop and evaluate LYMPH-V, a wearable arm volume measurement device and mobile application designed for the prevention and early detection of breast cancer-related lymphedema.
Methods & Materials: The study consists of two phases. In the first phase, the LYMPH-V wearable device and a supportive mobile application will be developed. The app will feature five core components: exercise modules, educational content, coping strategies, arm volume measurement/recording, and personalized reminders. Content will be created based on current guidelines and expert opinions. In the second phase, the effectiveness of the intervention will be assessed through a pilot randomized controlled trial, a reproducibility study, and usability evaluations. The device uses stretch sensors to monitor arm volume, and the mobile app provides alerts if measurements suggest early signs of lymphedema. Data will be stored securely and shared with healthcare professionals upon user approval.
Results: Expected outcomes include high usability, strong agreement with manual measurements, and improved capacity for at-home lymphedema monitoring and prevention.
Conclusion: LYMPH-V offers a promising digital solution that empowers survivors and healthcare providers through home-based arm volume tracking. This approach may facilitate early intervention, reduce healthcare burden, and enhance quality of life for breast cancer survivors.

Background & Aim: Emergency nurses face unique stressors that increase their occupational stress. Most existing tools measure general stress and overlook emergency-specific factors. This study aimed to assess the psychometric properties of the Persian version of the Stressor Scale for Emergency Nurses.
Methods & Materials: This is a cross-sectional study that used the forward-backward method to translate the tool from English to Persian. Face and content validity were assessed by five emergency nurses and five nursing faculty members, respectively. Construct, known-group, and convergent validity were tested in 198 emergency nurses from Saqqez and Sanandaj hospitals (2024). Test-retest reliability was evaluated in 21 nurses over two weeks. Internal consistency was measured using Cronbach’s alpha and McDonald’s omega. Data were analyzed using Jamovi 2.4.14.
Results: Face and content validity were satisfactory. Exploratory factor analysis identified four factors—conflicts, life and death situations, patients' families' actions and reactions, and technical/formal supports, which explained 60.64% of total variance. Convergent validity showed a correlation of 0.554 between job stress scores based on the Stressor Scale for Emergency Nurses and the Brief Nursing Stress Scale. Known group validity revealed that occupational stress scores were higher in women than men, and there was a significant negative correlation between occupational stress and work experience in the emergency department. Cronbach's alpha and McDonald's omega coefficients were 0.953 and 0.954, respectively; the intraclass correlation coefficient was 0.943.
Conclusion: The Persian version of the stressor scale shows strong psychometric properties and is reliable for assessing occupational stress in emergency nurses.

Background & Aim: Sepsis is a major global health issue, often leading to delayed recognition due to its varied symptoms. ICU nurses play a crucial role in early detection, but knowledge gaps in sepsis assessment and management persist. This study aimed to examine critical care nurses’ knowledge and experience of caring for patients with sepsis.
Methods & Materials: A cross-sectional correlational study was conducted on a convenience sample of 320 ICU nurses from various hospitals in Jordan. A Validated tool assessed nurses’ knowledge and experience of sepsis management.
Results: Nurses demonstrated moderate knowledge, with an overall score of 9.76 ± 1.43. Hypotension (51.6%) was the most recognized symptom, and 94.7% understood sepsis involves an infection with an inflammatory response. However, knowledge gaps remained, with only 31.9% knowing antibiotics should be given within 2 hours and 73.4% recognizing they should be administered before blood cultures. Regarding SIRS criteria, only a small percentage correctly identified key signs, such as temperature <36°C (26.3%) and heart rate >80 bpm (23.8%). Sepsis risk factors like IV drug use (34.4%) and chronic steroid use (21.9%) were recognized, but fewer identified the elderly (10.6%) as high-risk. Hypotension (50.9%) was the most challenging aspect of care. Nurses emphasized the need for better education (50.6%) and improved treatment protocols (46.9%).
Conclusion: This study highlights critical gaps in ICU nurses’ knowledge and experience in assessing and managing sepsis. The findings identified region-specific barriers and the urgent need for tailored training programs in resource-limited critical care settings.

Background & Aim: Happiness is essential for the success of nursing students, but it is often challenged by academic, clinical, and personal stressors. The COVID-19 pandemic further disrupted nursing education, adversely affecting mental health and potentially impacting students’ happiness. This study aimed to examine factors influencing nursing students’ happiness in the post-pandemic era to inform interventions for improved well-being and future success.
Methods & Materials: A cross-sectional study was conducted on 250 full-time nursing students at a university in Vietnam. A proportional sampling method was applied. The Brief Resilience Scale, Multidimensional Scale of Perceived Social Support, and Oxford Happiness Questionnaire were used to assess participants’ resilience, social support, and happiness, respectively. The ANOVA test, Pearson's correlation coefficient, and multiple linear regression were employed to analyze data with a p-value less than 0.05.
Results: The mean happiness score of nursing students was 3.99 (SD=0.51) out of 6. Reason for enrolling in nursing (p=0.021), satisfaction with the nursing field (p<0.001), perceived health status (p<0.001), resilience (r=0.493, p<0.001), and social support (r=0.628, p<0.001) were related to happiness. Perceived health status (β=-0.214, t=-0.214, p<0.001), resilience (β=0.322, t=7.373, p<0.001), and support from family (β=0.361, t=5.316, p<0.001) were predictors of happiness.
Conclusion: The study revealed a moderate level of happiness among nursing students in the post-pandemic era. Key determinants of happiness included perceived health status, resilience, and family support. These findings emphasize the importance of institutions to prioritize interventions aimed at enhancing resilience, promoting healthy lifestyles, and strengthening family support systems.

Background & Aim: Providing quality care to hospitalized psychiatric patients is vital, but many barriers hinder it. This study aimed to identify the barriers faced by nurses working in psychiatric wards in providing care for inpatients with mental disorders.
Methods & Materials: This qualitative study used a conventional content analysis approach and was conducted from July 2023 to September 2024 in three hospitals in Iran. Twenty psychiatric nurses with at least six months of experience were selected through purposive sampling. Data were collected through 20 semi-structured interviews (about 45 minutes each) and analyzed using conventional content analysis with MAXQDA software (Version 10).
Results: The findings revealed two main categories of barriers that psychiatric nurses face. The first, individual-social-professional factors, include nurses' inappropriate perceptions and actions, societal and family misconceptions about psychiatric care, and mental fatigue. The second, organizational-managerial factors, include staff shortages in both quantity and quality, excessive workload, management misunderstandings about psychiatric care, lack of organizational support, lack of effective guidelines, unfavourable physical environment, inadequate healthcare and recreational facilities, and lack of financial support for nurses. In particular, lack of knowledge about mental disorders and perceived institutional neglect emerged as major barriers that significantly reduced nurses' motivation and compromised the overall quality of psychiatric care.
Conclusion: This study highlights the complex barriers to optimal psychiatric care. Overcoming these challenges through targeted interventions, such as enhancing professional support systems and organizational reforms, is essential to fostering a more conducive care environment. These measures can improve psychiatric care quality.

Background & Aim: Patient dignity is a fundamental aspect of human rights, particularly when individuals are most vulnerable. Although maintaining patient dignity seemed to be challenging in Critical Care Units due to the complexity of medical procedures and critical condition of patients, a paucity of evidence exists exploring dignity preservation in Critical Care Units as well as its requirements from the patients' perspective. Thus, we aimed to explore patients’ dignity in Critical Care Units and the requirements for its preservation.
Methods & Materials: This qualitative study was conducted on 20 patients selected from the Critical Care Units of Imam Khomeini Hospital, Tehran, Iran, through purposeful sampling. Data were collected via semi-structured interviews and were analyzed using Graneheim and Lundman’s conventional content analysis method. Interviews explored patients' experiences and expectations regarding dignity preservation.
Results: The analysis revealed three main categories and nine subcategories essential for preserving patient dignity in Critical Care Units: (1) Care Ethics: Informed Decision-Making, Respecting Patient Concerns, and realistic interaction; (2) Humanity Preservation: Empathetic Acceptance, Avoiding Objectification, and Maintaining Patient Privacy; and (3) Personalized Care: Identifying Needs Proactively, Adapting Care to Individual Conditions, and Ensuring Comfort and Well-being. Participants emphasized the importance of empathetic communication, respect for their personal values and preferences, and maintaining a clean, comfortable environment.
Conclusion: The findings highlight the necessity for healthcare professionals to engage in ethical care, foster empathetic patient interactions, and proactively address the unique needs of each patient to enhance dignity preservation in critical care settings.

Background & Aim: Sleep disturbances are prevalent in cardiac intensive care units. Due to the side effects of sleep medications, complementary methods are recommended. This study aimed to assess the impact of red light on the sleep quality of patients in cardiac intensive care units.
Methods & Materials: In a randomized clinical trial, 80 patients at the CCU at Shahid Beheshti Hospital in Kashan, Iran, in 2024. The participants were allocated to two groups using block randomization. In the intervention group, red light replaced the white light in the room for two consecutive nights from 10 pm to 6 am. In the control group, no changes were made to lighting. The sleep quality, insomnia severity, and frequency of insomnia causes of the patients in both groups were assessed before the intervention and on the first and second days after the intervention using the St. Mary's Hospital Sleep Quality Questionnaire. Data were analyzed using chi-square tests, independent t-tests, repeated measures ANOVA, Friedman tests, and Cochran test (SPSS V: 19).
Results: There was no statistically significant difference between the two groups before the intervention in terms of demographic information and sleep quality score (P>0.05). The sleep quality score of patients in the intervention group was higher after the intervention than in the control group (p=0.001). A statistically significant difference was observed between the two groups in the first and second days after that for sleep quality score and frequency of insomnia, and insomnia severity (P= 0.001). Comparing the scores of the dimensions of Sleep Latency, Awake onset latency, the duration of the entire sleep process, and napping before and after the intervention in the two groups showed that the two groups did not have a statistically significant difference in these dimensions before and the first and second days after that (p>0.017).
Conclusion: Red light led to an improvement in sleep quality scores and a reduction in the severity and frequency of insomnia in patients admitted to the cardiac intensive care units. Its simplicity and low cost make it a recommended approach for improving their sleep.

Background: The coronavirus disease (COVID-19) pandemic challenged the physical and psychological well-being of critical care nurses because of the increasing number of infected patients, demands of care and shortage of healthcare front-liners, particularly nurses. Therefore, critical care nurses were the most affected and at risk of experiencing burnout.

Purpose: This study determined nurses’ perceived demands and the significant predictors of their burnout level in critical care units of tertiary hospitals in Saudi Arabia during the COVID-19 pandemic crisis.

Methods: This study used a cross-sectional research design. It was conducted from November to December 2021. Two hundred seventy nurses working in critical care units of tertiary hospitals in Saudi Arabia were surveyed using adopted questionnaires: Nurses’ Perceptions and Demands Regarding COVID-19 Care Delivery Questionnaire and Maslach Burnout Inventory. Participants were recruited through non-probability convenience sampling. Descriptive and inferential statistical procedures were applied with statistical significance set at p-value less than 0.05.

Results: The findings of this study revealed that the nurses’ demands concerning safety (M=2.84; SD=0.37), communication and relationships between team members (M=3.16; SD 0.63), and psycho-socio-emotional aspects (M=2.73; SD=0.49) were moderate, whereas their demands concerning organisation (M=2.23; SD 0.58) and decision-making (M=2.53; SD 0.58) were slight. Furthermore, the overall score on their levels of EE (M=32.46; SD=6.06) and DP (M=17.91; SD=3.77) were high; PA (M=28.84; SD=4.57) was low which indicates a high level of occupational burnout. Interestingly, the correlations between the dimensions of burnout and perceived demands were highly significant (p<0.001). Safety demand significantly predicted emotional exhaustion. Additionally, safety, organisation, and communication and relationships between team member’s demands were significant predictors of depersonalisation and personal accomplishment.

Conclusion: Nurses experienced imbalanced workloads in critical care units due to staff shortage and the increasing demand to provide care to patients infected with COVID-19. These situations increased their likelihood of experiencing physical and psychological pressure. Additionally, they experienced increased emotional distress and frustration in conveying their feelings of exhaustion that led to high burnout levels.