Beyond protocol versus judgment: A qualitative study of nurses' prioritization and integration strategies.

Tacrolimus for Active Ulcerative Colitis? Yes! (Even Though Cochrane Says “No”)

BackgroundPosttraumatic stress disorder (PTSD) and posttraumatic growth (PTG) represent divergent outcomes following trauma exposure in high-risk professions. This investigation examined the complex interplay between PTSD, PTG, and resilience in relation to occupational safety behaviors among Turkish firefighters.MethodsA multi-site cross-sectional study was conducted across five metropolitan fire departments in Turkey (N = 122). Participants completed validated psychometric instruments including the PTSD Checklist for DSM-5 (PCL-5), Posttraumatic Growth Inventory-Expanded Form (PTGI-X), Brief Resilience Scale, alongside detailed evaluations of safety practices, perceptions, and behaviors that assessed protocol adherence, equipment maintenance, training attendance, and safety communication metrics. Hierarchical multiple regression and chi-square analyses examined the relationships between psychological factors and safety outcomes, with particular attention to moderating effects.ResultsAnalyses revealed significant associations between psychological adaptation patterns and safety-critical behaviors. PTSD symptomatology demonstrated negative correlations with safety protocol adherence (r=-.24, p <.01) and safety awareness (r=-.21, p <.01). PTG manifested distinct cultural patterns, with Personal Strength emerging as the predominant domain (M = 3.10, SD = 1.08). A distinct disparity emerged between technical and psychological safety dimensions, with high adherence to equipment-related protocols (breathing apparatus maintenance: M = 4.00) contrasting markedly with poor implementation of psychological safety practices (comfort in communicating safety concerns: M = 1.66). Regression analyses indicated that psychological factors accounted for 28% of the variance in safety performance metrics, with resilience moderating the relationship between PTSD symptomatology and safety outcomes.ConclusionsThis investigation identifies critical relationships between psychological adaptation and occupational safety in firefighting, revealing how PTSD symptoms and PTG distinctly influence safety behaviors through culturally mediated patterns. The significant gap between adherence to technical safety protocols versus psychological safety practices underscores the need for integrated interventions that address both domains. These findings support developing comprehensive programs that enhance psychological resilience while maintaining technical safety standards in emergency services, suggesting a paradigm shift in occupational safety approaches for high-risk professions.

Well-designed simulation-based learning (SBL) experiences enhance students' self-confidence, self-efficacy, clinical judgment, and psychomotor skill development. An emerging concept in SBL research is psychological safety. There is currently no research on factors influencing psychological safety specifically related to the SBL environment, nor is there any literature found to determine whether intrinsic student characteristic, such as self-compassion and resilience, contributes to SBL learning outcomes. The aim of this study is to determine whether there is a relationship between nursing students' intrinsic characteristics (self-compassion, resilience, and anxiety sensitivity) and their psychological safety. Bivariate correlation was used to examine associations among sociodemographic variables and outcome variables. Multiple regression was used to determine the predictive nature of the sociodemographic variables. Assumptions for variables in multiple regression models were tested (normal distribution, heteroscedasticity, multicollinearity). All data were analyzed in SPSS, Version 28. The P value of significance was set at 0.05 for all analyses. Most of the 118 participants were non-Hispanic (89%), White (65%), and females (95%). Results of the demographic bivariate analysis revealed no significant differences among this diverse group or semester in the curriculum for psychological safety. The multiple regression found self-compassion (β = 29, P = 0.004), anxiety sensitivity (β = -0.16, P = 0.049), and resilience (β = 0.26, P = 0.004) predict psychological safety. The importance of creating a psychologically safe learning environment has been recognized as essential to best practices. Our findings suggest that an understanding of student characteristics that impact their perception of psychological safety will allow educators to develop strategies to better support learners in the simulation environment.

Picking Up the Pieces: Healthcare Quality in a Post-COVID-19 World.

Professional autonomy in 21st century healthcare: Nurses’ accounts of clinical decision-making

The objective of this research is to investigate the complex relationships that exist between psychological safety, employee motivation, and flourishing in organizational settings. Specifically, the study will concentrate on developing creative work environments and analyzing the roles played by transformational and transactional leadership styles. The understanding of psychological safety as a fundamental component of an atmosphere where taking interpersonal risks is encouraged and enables staff members to freely interact, make suggestions, and work together without fear of consequences is at the heart of the inquiry. Based on positive psychology frameworks and self-determination theory, the study clarifies the several motivating factors—like relatedness, competence, and autonomy—that lead to employee thriving. It seeks to understand how these motivational elements, along with psychological safety, foster an atmosphere that is favorable to creativity and invention. The study explores the complex interrelationships between transactional and transformational leadership philosophies and how each influences psychological safety and encourages workers to come up with new ideas. The primary goal of the inquiry is to clarify how these leadership philosophies affect the individual and group creativity of employees. Through an analysis of the complex relationships between psychological safety, employee motivation, and leadership styles, the thesis seeks to provide practitioners and organizational leaders with practical advice. It is crucial to comprehend how these elements combine to influence creative work practices and inventive behaviors in today's dynamic and competitive environment, where innovation is essential to long-term success. Keywords: Innovative work behavior, Employee creativity, Transformational leadership style and Transactional leadership style.

The aim of this study was to determine what is currently known about just culture's impact on nursing students' development of self-confidence with clinical judgment. Graduates of nursing programs must execute sound nursing judgment to provide safe client care. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guided the scoping review. The review elicited 1,411 sources and included 18 data sources. Just culture was found to provide elements of trust, fairness, and psychological safety needed by nursing students to be self-confident in learning and executing clinical judgments that promote client safety. Just culture promotes client safety in nursing education. Limited information exists on just culture's influence on student self-confidence with clinical judgment; more research is therefore required.

Background: Working directly with traumatised individuals can result in secondary traumatic stress and vicarious trauma in staff. Less research has been conducted into the impact of working with trauma on an organisation, including teams and structures. The population of Northern Ireland has a history of socio-political conflict, and trauma services may be uniquely impacted due to the dual personal and professional exposure to trauma. This research explores the organisational culture of a trauma service in Northern Ireland, investigating ‘What are the tangible and intangible elements of organisational culture of the Regional Trauma Network?’ Methods: Semi-structured interviews (n = 10) were conducted with staff-grade and managerial Multi-Disciplinary Team staff across all five Health and Social Care Trusts. Reflexive Thematic Analysis identified three themes and respective subthemes that characterise the organisational culture of the service. Results: Theme one: ‘Vision vs Reality’ with two sub-themes: ‘Vision of Excellence’ and ‘Absent Strategic Direction’. Theme two: ‘Together We Stand’ with two sub-themes: ‘Psychological safety’ and ‘You’re more than just a number’. Theme three: ‘Them and Us’ with three sub-themes: ‘Mirroring the Historical Context’, ‘Fragmented Services’ and ‘Fear of Consequences’. There is hope in the vision for an excellent service, and this is demonstrated in the cohesive local trust teams, yet feels absent within the fragmented regional service. Conclusions: The history of the socio-political conflict may be mirrored within the Regional Trauma Network. Psychologically safe and close-knit local trust services work within a wider fragmented service, with limited communication between various parts. The cohesion and collaboration within the HSC Trust teams may help to inform regional service development going forward.

This study investigates the integration of feature films and television series (FF/TV) into higher education teaching through the lens of the Teacher Agency and Professional Autonomy (TAPA) model. While FF/TV is recognised for its potential to enhance student engagement, facilitate learning diversity and create interactive teaching environments, challenges such as cognitive overload, emotional bias, and the need for critical media literacy persist. Drawing on survey responses (n = 50) and semi-structured interviews with 18 university lecturers across disciplines in Australia, the study reveals how educators exercise teacher agency and professional autonomy in their decision-making processes. Findings show that the teacher agency is not linear but influenced by past experiences, present evaluations, and future aspirations—key dimensions of the TAPA model. Moreover, educators’ perceived autonomy varies according to institutional support, professional space and personal beliefs, affecting FF/TV integration strategies. The study emphasises the need for structured yet adaptable institutional support to enhance teacher agency, suggesting that collaborative learning and interdisciplinary engagement can refine FF/TV-based pedagogy. By exploring these dynamics, the study offers practical insights into balancing student engagement, critical analysis, and media literacy within a nuanced framework of professional autonomy.

The predictive validity of ratings based on Katz' Index of ADL (Activities of Daily Living) and of physician ratings of patient outcome was studied in a department of internal medicine, 129 patients, 65 years of age or older, were assessed independently and simultaneously by licensed practical nurses using Katz' Index of ADL and by a physician using clinical judgement. These assessments were related to observed outcome regarding survival or death in the ward, length of stay, and type of hospital discharge. Two alternative ADL-groupings were used, grade A-E versus grade F-G and grade A-F versus grade G. Sensitivity and specificity of ADL-ratings and of physician ratings were found to be rather similar regarding length of stay less than 10 days and discharge to own home. Predictions regarding patient deaths based on ADL-grades F-G and G had a higher sensitivity than predictions based on physician ratings. The specificity of the two types of predictions was about the same. There was only a fair correlation between age and ADL-grade. ADL-assessments may thus be useful for planning purposes for elderly patients also in acute medical wards.

The aim of this study was to develop and evaluate the effectiveness of a clinical judgment support program using mixed reality (MR) for the observation of postoperative patients. This study employed a randomized controlled trial design, with 34 fourth-year nursing students as participants. The students were randomly allocated into two groups: a traditional simulation group (Sim group, n = 17) and an MR group (n = 17). Both groups were tasked with observing postoperative patients and making clinical judgments. The Sim group engaged in patient observation through classical simulation, followed by a debriefing session with the investigator. The MR group observed the patient according to the procedure displayed on HoloLens2 and conducted the self-debriefing using the developed program. Key outcome measures included educational time, the number of items observed, motivation for learning, satisfaction, confidence, and participant feedback. The results indicated that the MR group was able to observe a more significant number of observation items. Additionally, while the simulation time was longer in the MR group, the debriefing time was shorter compared to the Sim group. Psychological safety was higher in the MR group, whereas the Sim group, which had individualized debriefing opportunities, reported significantly increased confidence and reduced anxiety. The findings suggest that utilizing MR-based materials for teaching postoperative patient observation is more efficient and effective in educating novice nursing students.

The rapid integration of generative artificial intelligence (GenAI) into undergraduate nursing education has prompted significant debate regarding its impact on the development of critical reasoning, inquiry skills, and clinical judgement. While some scholars argue that reliance on GenAI may undermine independent thinking, contextual decision‑making, and autonomous judgement, emerging perspectives suggest that GenAI has the potential to enhance rather than erode these foundational competencies. This commentary examines the evolving role of GenAI in nursing education and argues that its thoughtful integration can strengthen students' preparedness for increasingly complex, technology‑rich clinical environments. Clinical judgement is central to safe nursing practice and is shaped by the nurse's interpretation of patient needs, contextual factors, and professional reasoning. While GenAI can synthesize large amounts of information efficiently, it does not replace human judgement; instead, it provides data that students must interpret within ethical, relational, and contextual dimensions of care. Integrating GenAI into educational contexts allows students to engage with realistic, data‑driven scenarios that mirror contemporary practice environments, supporting deeper analytical thinking and the ability to critique algorithmic outputs and biases. At the same time, the use of GenAI raises epistemological tensions between nursing's humanistic ways of knowing and AI's computational logic. These tensions underscore concerns that tacit knowledge, ethical reasoning, and patient‑centered judgement may be marginalized if GenAI tools are used uncritically. Addressing this challenge requires adapting nursing theory and curriculum to incorporate digital epistemologies while maintaining the profession's ethical and relational foundations. This commentary concludes that rather than discouraging GenAI use, nursing education must embrace it deliberately and ethically. Through intentional curriculum design, faculty development, and emphasis on AI literacy, educators can ensure that nursing students emerge as competent, reflective practitioners capable of navigating GenAI‑enabled healthcare environments with confidence and integrity.

Background:Clinical judgment development is necessary because it leads to appropriate nursing diagnoses, clinical decision-making and health promotion.Objectives:In this study we explored the process of Iranian nurses’ development in clinical judgment.Patients and Methods:This qualitative study was conducted in 2013 at hospitals of Kurdistan University of Medical Sciences, located in the Sanandaj city of Iran. The data were collected based on semi-structured interviews and the study included 24 participants. Data analysis was carried out concurrently with data collection using the grounded theory method.Results:The study participants’ main concern was ‘being non-professional in clinical judgment’. In response to this concern, they were struggling for gaining professional autonomy, striving for integrating clinical judgment skills, scrambling to make effective educational interventions and striving for professional and inter professional collaboration in clinical judgment. The core category was ‘struggling for becoming professional in clinical judgment development’. When nurses were supported professionally, they were able to develop their professional clinical judgment.Conclusions:The findings of this study provided critical information about nurses’ professionalization in clinical judgment. Accordingly, the participants adopted different strategies to develop their clinical judgment ability. Integrating these strategies into nursing theory and clinical education can improve nurses’ clinical judgment ability.

Bacteriemia adquirida en la comunidad: elaboración de un modelo de predicción clínica en pacientes ingresados en un servicio de medicina interna

Civility, psychological safety, and effective stress management are essential for meaningful learning conversations. Incivility triggers fear and humiliation, impairs clinical judgment and learning, reduces psychological safety, and increases cognitive load. These factors converge to make learners less likely to incorporate feedback, speak up when there is a problem, and discuss practice errors and patient safety issues. The authors combined the Basic Assumption and the PAAIL (Preview, Advocacy1, Advocacy2, Inquiry, and Listen) conversational strategy to help surface (rather than obscure) both educators' and learners' thinking. The synergy of these 2 strategies allows educators to identify individual learning needs and develop the learners' clinical judgment skills. This process improves learning by reducing incivility and cognitive load, improving psychological safety, and strengthening clinical judgment skills. This conversational strategy can minimize stress and anxiety in learners and optimize learning.