Background & Aim: Workplace violence is a growing concern within healthcare systems worldwide and poses serious risks to the well-being of nurses and other healthcare workers. Although several studies address this issue in Pakistan, no comprehensive national estimate exists. This study aims to synthesize the reported prevalence of different forms of workplace violence against nurses and healthcare workers in Pakistan through a systematic review and meta-analysis.
Methods & Materials: A systematic literature search was conducted across major electronic databases from January 2000 to October 2025. Twenty-six cross-sectional studies met the inclusion criteria. Methodological quality was assessed using the JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies. Pooled prevalence estimates were calculated using random-effects models in STATA version 17. Heterogeneity was evaluated with the I2 statistic and Cochran’s Q test, and potential small-study effects and publication bias were examined using Egger’s regression test and the trim-and-fill method.
Results: The meta-analysis shows that the pooled prevalence of physical and verbal workplace violence among healthcare workers is 20.0% (95% CI: 15.0%–25.0%) and 57.0% (95% CI: 48.0%–66.0%), respectively. Pooled rates for sexual and psychological violence are 13.0% (95% CI: 4.0%–22.0%) and 41.0% (95% CI: 18.0%–64.0%). In subgroup analyses by profession, nurses experience higher rates than other healthcare workers across categories: physical (29.3% vs. 16.1%; p = 0.003) and verbal (62.7% vs. 55.3%; p = 0.455). Meta-regression reveals no significant trend over time.
Conclusion: Workplace violence is highly prevalent among healthcare workers in Pakistan, with a particularly substantial burden observed among nurses. Although this review synthesizes prevalence rather than downstream clinical consequences, documented literature indicates that such pervasive exposure jeopardizes healthcare workers’ psychological well-being, job satisfaction, and overall quality of care. Targeted institutional policies, robust incident reporting systems, and multi-level protective interventions are urgently warranted to enhance occupational safety across healthcare settings.

Background & Aim: Given the critical role of the nursing profession in healthcare delivery and social welfare, and the increasing recognition of toxic leadership behaviors in clinical environments, it is essential to assess such behaviors using valid and reliable instruments. This study aimed to assess the psychometric properties of the Persian version of the Toxic Leadership Behaviors of Nursing Managers Scale (ToxBH-NM).
Methods & Materials: This descriptive cross-sectional study was conducted in 2025 to translate and evaluate the psychometric properties of the Persian version of the Toxic Leadership Behaviors of Nursing Managers Scale (ToxBH-NM). The study included 282 nurses from five teaching hospitals affiliated with Shahid Beheshti University of Medical Sciences in Tehran, Iran. Participants were selected using a multistage sampling method and completed questionnaires on demographics, job satisfaction, turnover intention, and the ToxBH-NM. Of the 300 distributed questionnaires, 18 were excluded due to incomplete responses and missing data, resulting in a final analysis performed on 282 nurses with complete and valid questionnaires. A methodological psychometric validation approach was used, including assessment of face, content, and construct validity, along with reliability analysis using Cronbach's alpha and the intraclass correlation coefficient (ICC).
Results: Face and content validity were confirmed (CVR = 0.96; S-CVI/Ave = 0.92). Confirmatory factor analysis supported the original four-factor, 30-item structure of the Persian ToxBH-NM Scale, with satisfactory model fit indices (χ²/df = 2.61, RMSEA = 0.079, SRMR = 0.048, CFI = 0.98, IFI = 0.98, TLI = 0.98, NFI = 0.97, and GFI = 0.91).
Cronbach's alpha coefficients ranged from 0.848 to 0.943 across the four dimensions and reached 0.967 for the total scale. Test–retest reliability showed high temporal stability (ICC = 0.98 for the total scale). Concurrent validity was supported by a significant negative correlation between the total toxic leadership score and job satisfaction (r = −0.189, p = 0.001), whereas no significant correlation was observed with turnover intention (r = −0.002, p = 0.974).
Conclusion: This instrument may support the assessment of toxic leadership behaviors among nursing managers and provide a foundation for future research and leadership development initiatives in the Iranian healthcare system.

Background & Aim: The transition from nursing education to clinical practice can expose newly graduated nurses to clinical, psychological, and organizational challenges. This study explored newly graduated nurses’ experiences during their transition to clinical practice in Indonesia.

Methods & Materials: A descriptive phenomenological design was used. Twenty newly graduated nurses from two tertiary teaching hospitals in Depok and Makassar were recruited through purposive sampling. Data were collected through two focus group discussions and analyzed using Colaizzi’s seven-step method.

Results: Three themes and eight subthemes emerged. The first theme described challenges in adapting to clinical practice, including heavy workloads, gaps between academic preparation and clinical realities, and psychological distress. The second theme reflected suboptimal preceptorship caused by insufficient preceptor availability, competing workloads, inconsistent supervision, and limited constructive feedback. The third theme represented nurses’ expectations for organizational commitment, continuing professional development, and structured credentialing support.

Conclusions: The findings indicate that transition to clinical practice is a multidimensional process shaped by individual readiness and organizational support. Nursing education institutions and healthcare organizations should develop integrated transition-to-practice programs that include standardized orientation, unit-specific learning, accessible preceptorship, psychological support, continuing professional development, and gradual delegation of clinical responsibilities.

Background & Aim: Ethical leadership and organizational communication climate are important factors associated with nurses’ organizational commitment and overall organizational performance in healthcare settings. This study aimed to examine the associations between nurses’ perceptions of ethical leadership, organizational communication climate, and organizational commitment.
Methods & Materials: This cross-sectional study was conducted with 265 nurses working at Ödemiş State Hospital in İzmir, Türkiye. Data were collected using a Sociodemographic Characteristics Form, the Ethical Leadership Scale, the Organizational Communication Climate Scale, and the Organizational Commitment Scale. Data were analyzed using IBM SPSS Statistics version 26.
Results: The mean scores were 32.9±8.7 for ethical leadership, 102.8±20.1 for organizational communication climate, and 61.7±10.3 for organizational commitment. Organizational commitment was positively correlated with ethical leadership (r=0.556, p<0.001) and organizational communication climate (r=0.617, p<0.001), and ethical leadership was strongly correlated with communication climate (r= .806, p< .001), supporting all three hypotheses. Both variables jointly explained 38.6% of the variance in organizational commitment (adjusted R² = .386, F (2, 262) = 83.92, p< .001). Communication climate had a stronger standardized coefficient (β = .48, p< .001) than ethical leadership (β = .17, p = .040) and more unique explained variance (ΔR² = .081 vs .010). Nurses with ≥10 years of institutional tenure reported higher communication climate scores than those with 7–9 years (Tukey HSD, p= .003).
Conclusion: Ethical leadership and organizational communication climate were significantly associated with nurses’ organizational commitment. When considered simultaneously, organizational communication climate showed a stronger association with organizational commitment than ethical leadership.

Background and Aim: Defibrillator competence requires cognitive and psychomotor skills, but instruments for assessing defibrillator skills are limited. Therefore, this study aimed to develop and evaluate the validity and reliability of a checklist for assessing defibrillator operation skills.

Methods and Materials: This methodological study was conducted in 2025–2026 at a Nursing School, in Tehran, Iran. The Defibrillator Operation Skills Assessment Checklist (DOSAC) was developed from the nursing curriculum, literature, 2025 AHA and ERC guidelines, and manufacturer documentation. Content validity was assessed by 10 experts using the Content Validity Ratio (CVR), Item- and Scale-level Content Validity Index (I-CVI and S-CVI), and modified kappa. Face validity was assessed by 15 nursing students and 15 nurses using qualitative assessment and Item Impact Score (IIS), respectively. Inter-rater reliability was evaluated in 20 nursing students assessed by two raters using a two-way random-effects Intraclass Correlation Coefficient (ICC), Cronbach’s alpha, and exact agreement.

Results: DOSAC contained 64 items across four scenarios: device preparation and patient monitoring, manual defibrillation, synchronized cardioversion, and AED use. All items met validity criteria. Mean CVR was .909, S-CVI/Ave was .989, modified kappa was .989, and mean IIS was 4.437. Reliability was excellent, with ICC = .986 for the total score, Cronbach’s alpha = .993, Pearson's r = 0.986, and 94.3% exact item agreement. Scenario-level ICCs ranged from .893 to .999 (all p < .001).

Conclusion: The DOSAC demonstrated strong content validity and excellent reliability and may provide a standardized tool for assessment of defibrillator operation skills in nursing education and practice.