The letter centres 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: 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: 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: Because of the high turnover rate among nursing personnel, contemporary medical facilities require more nurses. Retaining nurses is critical to ensuring patient safety and preventing malpractice.

Objective: The purpose of this research was to investigate the relationship between work embeddedness and nurse turnover intentions.

Methods: This descriptive analytic study included 242 nurses from hospitals affiliated with Zahedan University of Medical Sciences. We chose participants using stratified random selection. We gathered information using a demographic questionnaire, the Global Job Embeddedness Scale, and a turnover intention questionnaire. We evaluated the data using independent t-tests, Pearson correlation coefficients, ANOVA, and multiple regression tests. 

Results: The Pearson correlation coefficient test found a significant and negative relationship between work embeddedness and the desire to leave among nurses (r = -0.3). Multiple regression analysis found that job embeddedness significantly influenced turnover intention, accounting for 9.2% of the variation (p < 0.001). 

Conclusion: The study concluded that high levels of work embedding are associated with a lower willingness to leave the profession. By preserving and increasing job embedding among nurses, it is feasible to lower the number of nurses leaving the profession, thereby improving patient care.

Background: 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 face significant challenges. This study explores the barriers to NCD management at CHCs in South Sumatra Province, Indonesia.

Methods: A qualitative descriptive phenomenological approach was employed to gain an in-depth understanding by healthcare workers in managing NCDs. Data were collected through semi-structured interviews with 12 health workers consist of nurses, doctors, midwives, and public health workers. Thematic analysis was used to data analysis.

Results: The thematic analysis identified five themes, namely Workload and limited resources;  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.

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 & Aim: The pain of arteriovenous fistula, fatigue and sleep disturbances are common problems in hemodialysis patients. Using lavender products can help reduce these problems. This study aimed to comparison the effects of lavender aromatherapy and lavender tea consumption on reducing pain and fatigue, as well as improving sleep quality in HD patients.

Methods and Materials: This study is a randomized clinical trial without blinding conducted at the Dialysis Center in Tabriz University of Medical Science from May to December 2022. Random allocation was done by randomizing the moved blocks. HD 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: The results showed that the scores of pain, fatigue and sleep quality after the intervention were statistically significant (P < 0.05) compared to before in the lavender tea group and lavender aromatherapy group; but in the control group there was no statistically significant difference (P < 0.05). Also, no statistically significant difference was observed between the lavender tea group and lavender aromatherapy group regarding the scores of sleep quality (P=0.428), fatigue (P=0.570), and pain (P=0.997).

Participants in the lavender tea group and lavender aromatherapy group had a lower score of subjective sleep quality (P<0.001), sleep latency, sleep duration, use of sleep medication, day time dysfunction (P for all <0.001), sleep disturbances (P=0.035), Total score of PSQI (P<0.001), fatigue (P<0.001), and pain (P<0.001) following the intervention compared to the control group. Following the intervention,

Conclusions: The findings of this study showed that the effects of lavender on the nervous system can be useful in improving the problems of dialysis patients, such as sleep quality, fatigue, and pain caused by needle insertion.

Hemodialysis, Lavandula, Fatigue, Sleep Quality, Pain, aromatherapy, complementary medicine

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.