In the current times, there is an increasing need to recognize the impact of social and structural factors impacting health care and care experiences of individuals. Increased structural vulnerabilities (e.g., structural stigma and discrimination) among individuals from underserved populations result in inequalities. The term health inequalities broadly refers to health differences and social structures, including health-damaging behaviors and unjust health conditions among underserved populations.

Background & Aim: Assessing team performance is crucial in developing effective management strategies within healthcare. Therefore, identifying reliable tools that accurately measure team competencies is essential. This study aims to review the existing evidence on valid instruments to evaluate high-performance teams in healthcare.
Methods & Materials: A scoping review was conducted according to the methodology proposed by the Joanna Briggs Institute. The study was based on the PCC framework (Population, Concept, and Context), concentrating on healthcare teams (population), tools for evaluating high-performance teams (concept), and all areas of professional practice (context). The literature search included databases such as CINAHL Complete (EBSCO), LILACS (BVS), MEDLINE Complete (PubMed), PsycINFO (EBSCO), and Scopus. Grey literature was searched on WorldCat and ProQuest Dissertations & Theses. Study selection took place in two stages: an initial screening of titles and abstracts to identify relevant studies, followed by a full-text review of the selected articles.
Results: Initially identified 1,104 articles and selected six for inclusion in this review. Four instruments were recognized for assessing high-performance teams in healthcare: the Mayo High Performance Teamwork Scale, the Ottawa Crisis Resource Management Global Rating Scale, the Trust, and the Team Performance Observation Tool.
Conclusion: The primary contribution of this study was the identification of tools that provide constructive feedback to facilitate the ongoing development of high-performance teams. The implementation of systematic, evidence-based strategies supported by these evaluation tools fosters a data-driven approach to clinical decision-making and enhances the overall quality of care.

Background & Aim: Skin injuries are frequent hospital complications, and the role of artificial intelligence in management remains unclear. This review aimed to identify, map, and analyze the evidence on the use of artificial intelligence in the assessment, monitoring, and management of skin injuries in hospitalized patients worldwide.
Methods & Materials: A scoping review was conducted following the Joanna Briggs Institute guidance and the PRISMA Extension for Scoping Reviews (PRISMA-ScR). Searches were carried out in Embase, PubMed, Scopus, CINAHL, Cochrane Library, Web of Science, SciELO, BVS, LILACS, and the CAPES thesis and dissertation catalog. Eligible sources included primary studies, technical notes, dissertations, and theses. All references were organized in EndNote Web and transferred to Rayyan to support duplicate removal and facilitate screening by reviewers.
Results: The search resulted in the identification of 1,240 studies, of which eight were included and published in English. Most studies are technological development studies with samples ranging from 10 to 5,729 images or participants. Studies have shown that artificial intelligence techniques applied to pressure injuries, including Convolutional Neural Networks, Random Forest, Support Vector Machine, and Extreme Gradient Boosting, improve detection, measurement, classification, risk prediction, and clinical decision support, potentially reducing workload and enhancing care safety.
Conclusion: The application of artificial intelligence in the domain of skin injuries revealed a variety of uses. However, it was predominantly focused on the specific context of pressure injuries in hospitalized individuals. Consequently, a noticeable gap in the literature was identified regarding alternative categories of injuries affecting this population segment.

Background & Aim: Breastfeeding is fundamental to maternal and infant health, yet rural populations face barriers to support due to limited infrastructure and geographic constraints. Although digital health technologies are increasingly used to promote maternal and child health, evidence on their acceptance and effectiveness in supporting breastfeeding among perinatal women in rural settings remains limited. This scoping review aims to examine digital interventions supporting breastfeeding areas and to identify their outcomes, challenges, and enabling factors.
Materials & Methods: Following the Joanna Briggs Institute methodology, systematic searches were conducted in Scopus, PubMed, Wiley Online Library, ScienceDirect, DOAJ, and Web of Science. Studies published in English between January 2015 and May 2025 were included. Two reviewers independently screened studies, with disagreements resolved by a third reviewer. Data were synthesized thematically, and methodological quality was assessed using the Mixed Methods Appraisal Tool (MMAT).
Results: A total of 22 studies (n=22) were included, identifying four categories of interventions: mobile health (mHealth) applications, messaging services (SMS/IVR), telelactation, and social media platforms. These interventions improved exclusive breastfeeding rates, maternal knowledge, confidence, and satisfaction with care. Key facilitators included culturally tailored content, hybrid human–digital models, and interactive features. Barriers were low digital literacy, poor connectivity, weak integration with health systems, and socio-cultural resistance.
Conclusion: Digital health technologies demonstrate significant potential to strengthen breastfeeding support in rural areas. Their effectiveness depends on accessibility, cultural relevance, and integration into existing health and community structures. The findings underscore the need for policies that promote digital equity, community-based design, and sustainable integration of technology into rural maternal care programs. Future research should also assess cost-effectiveness and long-term user engagement.

Background & Aim: Prematurity is the leading cause of death among children under five years of age globally. Alarmingly, in low-income countries, more than 90% of extremely preterm-born babies die within the first few days of life. Kangaroo care is an effective method in the management of preterm babies. The study aimed to explore perceptions and experiences of postnatal mothers on Kangaroo care at a selected hospital in Sri Lanka.
Methods & Materials: This exploratory descriptive qualitative study was carried out with seventeen purposively selected postnatal mothers who were practicing Kangaroo care in the Neonatal Care Unit at District General Hospital in Kalutara, Sri Lanka. Data collection was done through in-depth interviews using an interview guide between the period of July 2021 and November 2021. The interviews were recorded and transcribed verbatim. The inductive content analysis method described by Graneheim and Lundman was employed for data analysis.
Results: Participants were mainly Sinhalese, married, and aged between 20-40 years. The analysis revealed one overarching theme: ‘Despite the obstacles, Kangaroo care is a blessing,’ which was further characterized by two main categories: positive perceptions and experiences, and negative perceptions and experiences. Positive perceptions and experiences are described under good practice, supportive role, and benefits. Negative perceptions and experiences are described under separation and obstacles.
Conclusion: The participating mothers’ perceptions and experiences of Kangaroo care blended with both positive and negative dimensions, which were shaped by contextual factors; hence, addressing these factors is imperative for the successful implementation of Kangaroo care.

Background & Aim: Work interruptions during medication administration increase the risk of errors, compromising patient safety and underscoring the need to examine the complex challenges nurses face in ensuring medication safety. The purpose of this study was to examine nurses’ experiences with interruptions during medication administration, their sources, impacts, and how nurses responded to and managed these situations.
Methods & Materials: A qualitative design was used, and in-depth interviews were conducted with sixteen nurses from tertiary hospitals in Korea using a semi-structured interview guide. Data were analyzed using directed content analysis based on an initial coding scheme.
Results: Three main themes and 10 sub-themes emerged from the analysis. Nurses reported interruptions from various sources, including healthcare colleagues, external departments, patients and caregivers, and environmental factors. These interruptions resulted in workflow fragmentation, elevated medication error risk, and significant emotional burden. In response, nurses employed various individual coping mechanisms while also identifying the need for organizational support.
Conclusion: Interruptions during medication administration stem from multiple sources and impose significant risks for errors, workflow disruption, and emotional burden on nurses. This study suggests that context-sensitive strategies, such as standardizing communication, delegating non-urgent requests, and enhancing education for healthcare providers, patients, and caregivers, are essential to reduce avoidable interruptions while supporting safe medication practices.

Background & Aim: Understanding predictive factors for complicated grief after COVID-19 losses is critical for developing targeted support strategies. This study aimed to examine predictors of complicated grief among Iranians who lost a family member during the pandemic.
Materials & Methods: This descriptive-correlational study was conducted from December 2022 to August 2023. A total of 150 relatives of COVID-19 victims were recruited via convenience sampling. Data were collected using the Inventory of Complicated Grief, the Burdened by Grief and Loss questionnaire, the WHO-5 Well-being Index, and a measure of pandemic-related burden. Data were analyzed using SPSS v. 26, employing chi-square, Fisher's exact test, and multiple logistic regression to identify predictors.
Results: The likelihood of developing complicated grief among women compared to men was 3.77 times higher (p<0.001, OR=3.77), and the chance of complicated grief in close family members compared to distant relatives was 4.55 times higher (p<0.001, OR=4.55). An increase in psychological well-being score significantly lowered the likelihood of complicated grief in bereaved companions (p<0.001, OR=0.86); however, an increase in being burdened by grief and loss scale significantly augmented the likelihood of complicated grief in bereaved companions (p<0.001, OR=1.11). However, an increase in the Burdened by Grief and Loss score significantly increased the likelihood of complicated grief in bereaved companions (p<0.001, OR=1.11). The prevalence of complicated grief in Iranian people who have lost their family members because of COVID-19 was higher compared to similar studies.
Conclusion: Female gender, close kinship with the deceased, and a heavier psychological burden of loss were significant risk factors for complicated grief, while stronger mental health served as a protective factor. Given the crucial role of nurses in bereavement care, there is an urgent need for structured, supportive interventions and psychological services, ideally delivered through clinical guidelines tailored for these vulnerable groups.

Background & Aim: Smartphone use in nursing education offers both learning benefits and risks of distraction, influenced by cultural and institutional norms. The Nursing Students’ Smartphone Use and Distraction Questionnaire, originally developed in Spanish but never psychometrically validated, was formally validated among Spanish nursing students and simultaneously translated, culturally adapted, and validated for Portuguese nursing students.
Methods & Materials: A psychometric study was conducted among 543 Portuguese and 480 Spanish nursing students enrolled in their second year or higher. The questionnaire was translated and culturally adapted into Portuguese following International Society for Pharmacoeconomics and Outcomes Research guidelines. Psychometric evaluation included exploratory factor analysis with varimax rotation, Kaiser-Meyer-Olkin measure, Bartlett’s test of sphericity, and internal consistency analysis using Cronbach’s alpha, conducted with IBM SPSS Statistics version 29.
Results: The analysis extracted 26 items across six factors: Clinical Practice Use, Regulatory Policy, Unprofessional Personal Use, Observed Unprofessional Use, Student’s Distraction, and Ethics, explaining 57.8% of the variance in Portugal and 61.8% in Spain. Kaiser-Meyer-Olkin values were 0.747 and 0.818, with Bartlett’s test significant in both samples (p < 0.001). Cronbach’s alpha coefficients for the total scale were 0.717 (Portugal) and 0.740 (Spain), with subscale values ranging from moderate to good reliability.
Conclusion: The Smartphone Use and Distraction Questionnaire showed valid structural properties and acceptable reliability in two distinct cultural settings. Its adaptability supports use across health professions and diverse countries and cultures, informing evidence-based policies that promote professional smartphone use and reduce distraction in clinical education.

Background & Aim: Communication limitations in intubated patients with respiratory failure increase anxiety, compromise care quality, and may delay ventilator weaning. This study evaluated the effects of a self-regulation program using iPad-assisted communication on anxiety, perceived fulfillment of care needs, and weaning outcomes.
Methods & Materials: A randomized controlled trial was conducted from April to December 2024 and enrolled 60 mechanically ventilated patients with respiratory failure. Participants were randomly assigned to an experimental group (n= 30) and a control group (n = 30). Data were collected on demographics, health status, anxiety levels, perceived fulfillment of care needs, and ventilator weaning outcomes. Statistical analyses included descriptive statistics, chi-square or Fisher’s exact tests, t-tests, and ANCOVA.
Results: Two hours after the intervention, the experimental group reported significantly lower anxiety levels and higher perceived fulfillment of care needs compared with baseline and the control group (p< 0.001). The experimental group also demonstrated a higher weaning success rate (83.33%) than the control group (66.67%) (χ²= 6.76, p= 0.009). Re-intubation within 48 hours was significantly lower in the experimental group (16.67%) than in the control group (33.33%) (χ² = 4.85, p = 0.028). The tracheostomy rate was lower in the experimental group (6.67% vs. 13.33%), but this difference was not statistically significant (χ² = 1.09, p = 0.296).
Conclusion: The self-regulation program with iPad-assisted communication reduced anxiety, enhanced perceived care needs, and improved weaning outcomes. These results support its applicability as a patient-centered intervention to optimize respiratory care in intensive care settings.

Background & Aim: The complexity of chronic kidney disease care necessitates multidisciplinary coordination, making it susceptible to care fragmentation. Electronic Health Records are strategic tools for integrating this care, but their effectiveness depends on the informatics competency of their users, mainly nurses. This study aimed to determine and compare the level of nurses' self-reported informatics competency before and after the deployment of specialized dialysis software in centers affiliated with Tehran University of Medical Sciences.
Materials & Methods: This longitudinal study was conducted in 2024 using a census sample of 51 nurses across seven hemodialysis centers. The standard Persian version of the Nursing Informatics Competency Assessment Tool was administered before and at least one month after software implementation. Data were analyzed using descriptive statistics, the McNemar Test, and the Paired Samples t-test.
Results: A statistically significant positive shift in nurses' categorical competency status (Sufficient vs. Insufficient) was confirmed by the McNemar test (p=.039). Specifically, 8 nurses shifted from Insufficient to Sufficient status post-implementation. Paired Samples t-tests on the subscales revealed a significant improvement in Information Literacy (mean difference: 5.02; p=.001) and Information Management Skills (mean difference: 3.10; p=.003). However, the change in Computer Literacy scores was not statistically significant (mean difference: 1.67; p=.117).
Conclusion: Direct, sustained, hands-on experience with electronic health records systems improves nurses' informatics competency, particularly in information literacy and information management, even without formal curricular education. This study highlights practice-based learning as an effective and viable strategy for cultivating essential informatics skills in technology-driven clinical environments.

Background and Aim: Nurse–physician collaboration is a fundamental component of interprofessional healthcare, in which nurses and physicians share responsibilities and professional goals to improve patient outcomes. Effective collaboration enhances clinical decision-making, patient safety, and quality of care. This study aimed to assess nurses’ perceptions of nurse–physician collaboration in emergency departments of Ministry of Health hospitals in the Gaza Governorate, Palestine.
Methods and Materials: A cross-sectional study was conducted between January and April 2023 using a census sample of 205 nurses working in emergency departments of Ministry of Health hospitals. Data were collected using the Jefferson Scale of Attitudes toward Physician–Nurse Collaboration, a validated fifteen-item self-administered questionnaire that measures attitudes toward collaborative practice. Higher scores indicate more positive perceptions. The scale includes four domains: shared education and collaboration, responsibility and role expectations, nurses’ autonomy, and physicians’ authority.
Results: The findings revealed a high level of nurse–physician collaboration in emergency departments of governmental hospitals in Gaza, with an overall weighted mean of 78.4 percent, indicating positive perceptions among nurses. Among the four domains, nurses’ autonomy ranked highest at 88.2 percent, followed by responsibility and role expectations at 87.9 percent, and shared education and collaboration at 87.3 percent. Physicians’ authority ranked lowest at 50.0 percent, suggesting a perceived imbalance in decision-making authority.
Conclusion: The study demonstrates a strong positive perception of nurse–physician collaboration among nurses in governmental hospital emergency departments in Gaza. However, the low rating of physicians’ authority highlights the need to further examine interprofessional dynamics. Nursing and medical leadership are encouraged to implement strategies that strengthen collaboration and to conduct further research from physicians’ perspectives across different hospital departments.