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: 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: 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). Reintubation 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 & 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: 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: There is a growing global reliance on sleep medications among healthcare professionals, raising concerns about dependency and health outcomes. This study aimed to assess the prevalence of insomnia, sleep medication usage, and their correlates among nurses. Methods & Materials: This cross-sectional study employed a web-based survey to recruit 1,213 nurses from university hospitals in East Azerbaijan Province, Iran, via institutional portals. Participants completed the Insomnia Severity Index and a profile of insomnia medication usage. The data were analyzed using descriptive statistics, analytical tests, and multiple linear regression in SPSS 21 (p < 0.05). Results: Among 1,213 participants (84.3% female, mean age 36.9 ± 8.5 years), the majority had subclinical (52.6%) or moderate (38.3%) insomnia. While 41.2% reported using non-drug methods for insomnia, 73.5% did not use any sleep medication. Among medication users, benzodiazepines (10.5%) and herbal remedies (9.5%) were most common. Nurses working rotating shifts (t = -5.93, p< 0.001) and those with >3-night shifts per week (F=19.41, p< 0.001) had higher insomnia severity scores. Multiple linear regression revealed that female gender (β= 1.780, p= 0.009), married status (β= 0.740, p= 0.009), non-use of benzodiazepines (β=-1.284, p = 0.004), and use of non-drug methods (β = -1.789, p< 0.001) were significantly associated with higher ISI score. Conclusion: Nurses exhibit high insomnia rates and medication dependence, necessitating urgent integration of non-drug approaches like optimized shifts and sleep hygiene programs to reduce severity and improve well-being.

Background & Aim: HIV screening is a crucial step in the prevention and treatment of HIV/AIDS, but challenges related to accessibility, efficiency, and service quality in many regions. With the rise of digital technologies, digital health applications hold significant potential to address these challenges. This review evaluates the opportunities and challenges of applying digital technologies in HIV screening, focusing on accessibility, privacy, and healthcare quality. Materials & Methods: A scoping review was conducted using the framework of Arksey & O'Malley (2005), as modified by Levac et al. (2010). Systematic searches were performed in PubMed, Scopus, DOAJ, Wiley Online Library, Cochrane Library, and EBSCOhost for studies published between 2015 and 2024. Relevant studies were selected based on criteria focused on technology accessibility, privacy, and infrastructure reliability. Data were extracted, mapped, and findings categorized by geographical context and key challenges. Results: Ten studies involving over 3,500 participants were analysed, including randomized controlled trials, observational studies, and program evaluations. Major challenges identified included limited access to technology, particularly in low-resource areas, as well as privacy concerns and technology reliability. Despite these challenges, significant opportunities to improve healthcare services through digital technologies were noted, especially when adapted to local contexts and supported by user training. Conclusion: Despite challenges in accessibility and privacy, digital technologies provide opportunities to enhance HIV screening, especially with contextual adaptations and user training. These findings suggest a path forward for integrating digital solutions in HIV care.

Background & Aim: Palliative care is an approach designed to enhance the quality of life and alleviate suffering associated with life-threatening illnesses. It should also be included in Home Care Services. This study aimed to identify the needs of patients in palliative care and their caregivers from the perspective of Home Care Service providers. Methods & Materials: This qualitative research study was conducted with a multidisciplinary team of providers under the Home Care Service program in the interior of São Paulo state, Brazil. Data were collected through semi-structured interviews and analyzed using the Content Analysis method. Results: Three categories emerged from the provider's narratives: insufficient knowledge about palliative care, the needs of patients in palliative care, and the needs of caregivers of patients in palliative care. Additionally, nine subcategories were identified: palliative care as end-of-life care, palliative care as an opportunity to provide comfort measures, lack of palliative care training for the multidisciplinary team, pain management, nutrition, emotional support, and psychological care, presence of family members, psychological support, and assistance in care management. Conclusion: This study identified the needs of patients in palliative care and their caregivers from the perspective of Home Care staff. The primary needs of patients, as identified by the staff, encompassed both physical and psychosocial support, including the presence of family members. For these patients’ caregivers, staff emphasized the importance of psychological support and assistance in managing care. The study highlights the importance of continuous education in the home palliative care setting that recognizes the needs of both patients and caregivers.

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