Evaluation of an innovative model for leadership and management development among national immunization program teams.

The role of the session moderator in scientific meetings is rarely described in the literature, although it directly influences the scientific, educational and institutional quality of conference sessions. Often perceived as an implicit or purely procedural role, moderation is in fact a specific skill requiring competencies in organization, communication, time management, scientific facilitation and education. Preparation before the session is essential and includes reviewing the programme, identifying session objectives, anticipating key discussion points and coordinating with co-moderators when necessary. Scientific transparency is also part of this responsibility, particularly by ensuring the declaration of conflicts of interest. During the session, the opening sets the tone, clarifies the rules and establishes a respectful and interactive atmosphere. Beyond time management, which remains a central responsibility, an important objective is to transform a sequence of presentations into a genuine scientific discussion by initiating questions, stimulating exchanges, encouraging dialogue between speakers and promoting audience participation. A significant educational responsibility also exists, particularly in supporting junior presenters and maintaining a constructive discussion environment. Adaptability is essential because the role varies according to session format. Effective moderation improves the overall quality of scientific meetings and should therefore be recognized and taught as an academic skill.

Acute mesenteric ischemia (AMI) remains one of the most lethal vascular emergencies, with in-hospital mortality rates frequently exceeding 50%. Although early diagnosis and timely revascularization are critical, clinical practice remains highly variable. This study aimed to evaluate the real-world management of AMI in Spain, identifying gaps in resources, protocols, and interhospital coordination. A national cross-sectional survey was conducted between March and August 2024 using the Survio® platform. The questionnaire was distributed to general surgeons through national surgical societies and included 27 items covering hospital infrastructure, clinical protocols, diagnostic and therapeutic availability, personal experience, and perceived system-level barriers. A total of 291 surgeons responded. The median age was 40 years (IQR: 17). Most were consultants (76.3%) working in tertiary (42.6%), secondary (33%), or community hospitals (24.4%). While 97.6% reported access to 24/7 multiphasic CT and 90.4% to round-the-clock radiology, only 51.9% had 24/7 interventional radiology and 60.1% vascular surgery. Just 26.8% had institutional AMI protocols. The median distance to a referral center was 25km (range: 2-250km), and 68.4% reported difficulty in patient transfers. While 96.9% felt competent managing AMI, only 36.4% were familiar with the term "intestinal stroke." A total of 76.3% expressed interest in joining a national AMI registry. Spanish surgeons report high self-perceived clinical competence in AMI management, but systemic fragmentation, lack of protocols, and logistical barriers limit optimal care. These findings underscore the urgent need for coordinated regional networks, standardized care pathways, and multidisciplinary collaboration to improve outcomes in acute mesenteric ischemia across European healthcare systems. Retrospectively registred and recorded in Clinical Trials. NCT06428240, registration date on 20th/05/2024.

ABSTRACT This study investigates the Research Data Management (RDM) skillsets and competencies of library professionals within North Indian university libraries. Employing a survey method, data was collected from professionals, resulting in an 84% response rate. The data, analyzed using SPSS. The study reveals that a significant number of library professionals require further development in several key areas. These include awareness of new government initiatives (e.g. Shodh Chakra), proficiency in metadata creation (e.g. using Dublin Core standards), and advanced technical ICT skills (e.g. data storage infrastructure and architecture). Additionally, there is a need for enhanced subject-specific knowledge, familiarity with various research methods (e.g. data analysis and visualization), and competencies in data description, documentation, and curation. The study also highlights the importance of skills related to developing Data Management Plans (DMPs), staying current with RDM trends through refresher courses, utilizing originality checking tools, and understanding legal, policy, and advisory aspects (e.g. intellectual property, ethics, and licensing). This research underscores the critical need for ongoing professional development to equip library professionals with the necessary competencies to effectively support RDM practices in academic environments.

Integration of home-based palliative care (PC) enables patients to receive care at home, fosters family involvement, and reduces healthcare costs. Despite its benefits, nurses report challenges in delivering competent PC, and limited research has explored how home care nurses perceive their own competence and self-efficacy within this context. The study aimed to explore Ontario nurses' perceived competence and self-efficacy in home-based PC delivery. It also examined the relationship between both constructs, perceived competence and self-efficacy. A cross-sectional design was used with 2 validated survey tools: the 10-domain Palliative Care Nursing Self-Competence scale and the 2-domain Palliative Care Self-Efficacy scale. Ontario home care and nursing organizations were contacted to assist with recruitment by disseminating a Qualtrics survey link via mass email to nurses who had provided home-based PC. A minimum of 219 participants was required based on a G*Power analysis. Data were collected over 2months with 2 reminder emails. Descriptive analysis and Spearman's rank correlation were conducted to address the research questions. Seventy-two registered nurses and 38 registered practical nurses reported the highest levels of perceived competence in addressing functional care, while spiritual care emerged as the most challenging domain. Self-efficacy was higher in psychosocial care than in symptom management. A strong positive correlation was found between perceived competence and self-efficacy (ρ=.69, p<.001), highlighting the interconnected nature of these constructs in home-based PC. Nurses' low perceived competence and self-efficacy in spiritual care and symptom management highlight gaps in meeting patients' holistic care needs. Nurses must be better equipped to manage the psychosocial and spiritual care needs of patients and families. Strengthening training and resources can enhance holistic PC delivery and nurses' preparedness, thereby supporting nurse retention and the quality and sustainability of home-based PC.

This study evaluated the impact of a dedicated perioperative nursing team on operating theatre efficiency in robotic-assisted spinal surgery. A structured training programme was developed for a team of four perioperative nurses to achieve competence and autonomy in robotic system management across all phases of care. Operative data were retrospectively collected and compared between a pre-implementation phase and a post-implementation phase. A total of 130 robotic-assisted spinal procedures were analysed, including 47 performed before and 83 after team implementation. Following introduction of the specialised nursing team, mean time to surgical start decreased from 67.5 to 61.1 min, and overall operative duration was significantly reduced from 253.9 to 195.0 min. Implant execution time remained stable (30.0 min) despite a significant increase in the mean number of pedicle screws implanted per procedure from 4.9 to 6.4. Efficiency per screw improved markedly, with time per screw decreasing from 7.0 to 4.8 min. Three robotic procedures were abandoned in the pre-implementation period due to workflow-related issues, whereas no procedures were abandoned after introduction of the dedicated team. These findings demonstrate that the implementation of a specialised perioperative nursing team is associated with substantial improvements in workflow efficiency in robotic-assisted spinal surgery.

ObjectivesWith the continuous increase in surgical volume in China and the relative shortage of anesthesiologists, anesthesia nurses (ANs) play an increasingly critical role in perioperative care, particularly in the Post-Anesthesia Care Unit (PACU). Competency in anesthesia medication management is essential for patient safety during recovery. However, the training and professional development of ANs in China remain underdeveloped, with no standardized certification or continuing education systems in place.AimThis study aimed to explore the current status, barriers, and potential pathways for improving anesthesia medication management competency among ANs in China.MethodsA qualitative descriptive design was employed, utilizing semi-structured interviews. Participants were selected via purposive sampling from a tertiary hospital in Chongqing between November and December 2025. Data were analyzed using Colaizzi’s seven-step phenomenological method with NVivo 12.0. Thematic analysis was conducted to identify key patterns and insights.ResultsAfter analyzing interview content, three main themes and nine subthemes were distilled: (1) Cognition and Value Orientation of Anesthetic Medication Mastery—ANs recognized the necessity of medication knowledge for patient safety but exhibited gaps in comprehensive understanding, particularly regarding less frequently used drugs; (2) Multidimensional Barriers Impeding Mastery—including fragmented training mechanisms, limited learning motivation and resources, inadequate organizational and policy support, and deficiencies in departmental management; and (3) Targeted Demands for Enhancement—ANs expressed a need for systematic training, standardized assessment, role clarification, and interprofessional collaboration, especially with anesthesiologists.ConclusionThe study highlights a significant disparity between the recognized importance of anesthesia medication management and the actual competency levels among ANs. Barriers are systemic, rooted in training fragmentation, limited resources, and unclear professional roles. To enhance medication management capacity, a structured, policy-supported approach is recommended, including standardized training programs, role specialization, interdisciplinary collaboration, and incentive-linked professional development. These measures are essential for advancing anesthesia nursing as a specialized discipline and ensuring patient safety in PACU settings.

The article investigates mechanisms for integrating management decisions into the higher education process within the context of digital transformation. The contemporary digital environment necessitates the development and implementation of comprehensive management systems aimed at forming students’ strategic thinking competencies and informed decision-making capabilities under technological uncertainty. The study aims to develop a conceptual model of management decisions for the digital educational environment of the university and identify key factors influencing its implementation effectiveness. The methodological framework employed a comprehensive approach, including analysis of existing digitalization practices in education, systematization of management tools, and expert evaluation of adaptive learning technologies implementation results. The empirical basis included 150 third-year students majoring in 38.03.01 “Economics” at the Financial University under the Government of the Russian Federation during September—December 2025. The study applied content analysis of digital educational platforms, expert interviews with faculty and program directors, and monitoring of academic performance and student engagement indicators. Results demonstrate that implementing management decisions through adaptive technologies contributes to a 28.3% increase in student motivation for specialized knowledge accumulation, a 34.7 % improvement in decision-making quality in educational cases, and a 31.9 % increase in self-efficacy levels. A significant relationship was established between the structuredness of management processes in the educational environment and students’ academic outcomes (r = 0.742, p &lt; 0.001). The theoretical significance lies in expanding understanding of mechanisms for developing management competencies in the digital educational environment. The practical value is determined by the applicability of the developed model for improving educational programs in economics, management, and related disciplines.

Alongside the physical burden of cancer and its treatments, women with gynecologic cancer face substantial psychological and social challenges that strongly shape quality of life. Adaptive coping and timely psychosocial support may facilitate adjustment, adherence, and rehabilitation. To summarize coping strategies used by women with gynecologic cancer and their association with quality of life, and to describe the role of the multidisciplinary care team in delivering psychosocial support. We conducted a systematic search of PubMed, ScienceDirect, Google Scholar, BioMed Central, AKJournals, and ResearchGate for studies published between 2018 and 2025 without language restrictions. The search yielded 1419 records; after screening and full-text assessment, 36 studies were included. We extracted data on coping patterns, psychological outcomes, quality of life, and the contribution of psychosocial care and communication. Adaptive coping - particularly problem solving and seeking social support - was associated with better emotional well-being, lower distress, and higher quality of life. Avoidant coping was linked to higher anxiety, depressive symptoms, and poorer quality of life. Structured psychosocial interventions and consistent, empathic clinician-patient communication reduced tension, strengthened trust, and improved adherence. Integrating psychosocial support into oncologic care for women with genital tumors can enhance adaptive coping and improve quality of life. A patient-centered, interdisciplinary approach should include decision-making support, early assessment of coping and psychological burden, timely referral to appropriate professionals, and continuous development of communication and patient management competencies among providers. Orv Hetil. 2026; 167(18): 691-701.

The aim of this study is to develop, test, and evaluate the effectiveness of a pedagogical model integrating artificial intelligence tools and “the flipped classroom” blended learning technology for developing key management competencies of students of an economic university. Materials and methods. The study utilized a combination of methods: theoretical analysis, a pedagogical experiment, expert assessment, and statistical data processing. The experiment was conducted at the Minsk branch of the Plekhanov Russian University of Economics during the 2021-2025 academic years with students majoring in “Business Informatics”, “Management”, and “Economics”, divided into control and experimental groups. Results. A comparison of the results of educational activities of students in the experimental and control groups demonstrates the high potential of a pedagogical model integrating artificial intelligence tools and “flipped classroom” technology for developing students’ management competencies, which in turn has a positive impact on their other educational and academic achievements. Conclusion. The integration of artificial intelligence technologies and “the flipped classroom” model creates a powerful educational foundation for the targeted development of management competencies of economic university’s students. This approach transforms the educational process from passive information acquisition into an active, practical learning environment, closely aligned with the realities of digital business. The key success lies in the synergy: artificial intelligence takes over the routine personalization and training of basic knowledge, while students and faculty focus on developing the unique qualities needed by future economic leaders — competence, communication skills, critical thinking, creativity, emotional intelligence, leadership potential, and self-confidence. The conclusion confirms the high effectiveness of the proposed integration, which ensures personalization, interactivity, and a practice-oriented educational process. The model can be scaled to other areas of management training.

Development and evaluation of an evidence-based training and supervision program to enhance clinical competence management in perinatal depression management among rural maternal and child health workers: A pre-post study.

Emergency Medical Services (EMS) centers, as the primary providers of urgent medical care, play a vital role in preserving lives during crises. Among the most complex and high-risk scenarios affecting prehospital EMS performance is wartime conditions. Accordingly, the present study sought to identify the principal challenges encountered by prehospital emergency centers in providing care during wartime conditions and to propose strategic, context-specific solutions aimed at enhancing their effectiveness in Iran. This qualitative study examines the difficulties prehospital Emergency Medical Services (EMS) centers in providing care in in Iran faced throughout the war and suggests tactical remedies. 26 participants, including top management and frontline EMS staff, participated in semi-structured interviews using purposive sampling. Graneheim and Lundman's content analysis methodology was used to examine the data. Four major themes emerged from the results: (1) Organizational and governance issues (inadequate infrastructure and resources and a lack of thorough wartime procedures), (2) Communication and dispatch issues (lack of wartime telephone triage protocols and GPS disruptions), (3) Professional issues (insufficient competencies in incident scene management and psychological preparedness), and (4) Cultural issues (low public awareness and crowding at incident scenes). The study comes to the conclusion that the safety, promptness, and efficacy of prehospital emergency care in wartime contexts may be greatly improved by addressing these issues through focused policy formulation, specialized training, enhanced communication systems, and public education. The results are a significant addition to emergency and disaster medicine in Iran and offer useful, context-specific insights for EMS leaders and policymakers.

Multicentre Delphi consensus-based development and validation of the Tele-ESSI-KAP scale: Assessing epilepsy competencies among school teachers.

To synthesise the available evidence related to nurses' pain assessment and management practices for patients with diagnosed mental health conditions. Mixed-methods systematic review. Medline, CINAHL, PsycINFO, SPORTDiscus and Psychology and Behavioural Sciences Collection. Databases search was conducted in March 2024 and updated in June 2025. Methodological quality was assessed using the Mixed Methods Appraisal Tool. Data synthesis followed the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis. Of the 1318 eligible studies identified, 12 met the inclusion criteria. The included studies were methodologically robust overall but frequently neglected nonresponse bias and were predominantly conducted in high-income countries, potentially limiting generalisability. The synthesis revealed diverse experiences among nurses in assessing and managing pain in patients with diagnosed mental health conditions. Six key themes emerged: Inadequate and Inconsistent Pain Assessments, Seeing is Believing, To Trust or Not to Trust the Patient, A Balancing Act, Diagnostic Overshadowing and Organisational Restraint and Support. This review highlights the ongoing challenges nurses encounter in assessing and managing pain and the need for enhanced education and institutional support to strengthen nurses' capacity for effective pain assessment and management in patients with diagnosed mental health conditions. Stigma, both structural and interpersonal, continues to shape clinical decision-making, often leading to under-assessment and inadequate treatment of pain. Integrating clinical judgement with validated pain assessment tools will help ensure nurses provide evidence-based pain management for this often-marginalised group. Enhancing nursing competence in pain assessment and management for patients with diagnosed mental health conditions leads to more accurate and timely pain relief, significantly improving physical and psychological wellbeing. Effective pain control for this vulnerable group can reduce hospital length of stay and minimise complications, ultimately contributing to better health outcomes and quality of life. No patient contribution. What problem did the study address?: Pain is a complex sensation affecting people with diagnosed mental health conditions. They are likely to receive inadequate pain assessment and management due to mental health conditions preventing them from accurately self-reporting their pain and advocating for timely treatment. This review explored the pain assessment and management practices among nurses for patients with diagnosed mental health conditions. What were the main findings?: Significant barriers were identified, including inconsistent use of pain assessment tools, limited knowledge and confidence among nurses, power imbalances in the nurse-patient relationship, diagnostic overshadowing where physical symptoms are presumed to be related to mental illness, and organisational constraints such as staffing shortages, lack of education and restrictive hospital policies. Strategies to mitigate these barriers are essential to improving pain outcomes and promoting person-centred care for this vulnerable population. Where and on whom will the research have an impact?: This review highlights the need for more robust approaches to the assessment and management of pain experienced by patients with diagnosed mental health conditions. It underscores the importance of integrating pain assessment, mental health and substance use education into nursing curricula and post-registration nursing practice. The findings highlight the need to update clinical guidelines and organisational policies, ensuring that nurses receive the necessary training, resources and support to provide effective pain management for patients with mental health conditions to enhance the quality of care and promote more equitable health outcomes for individuals with mental health conditions. Joanna Briggs Institute (JBI) Manual for Evidence Synthesis and Preferred Reporting Items for Systematic and Meta-analysis (PRISMA) reporting guideline for systematic reviews. None.

Background: Effective sick-day management, including ketosis home management aimed at preventing diabetic ketoacidosis (DKA), is essential for families living with a child/adolescent with type 1 diabetes (T1D). Methods: Adolescents living with T1D and caregivers of younger children living with T1D were invited to participate in an interview consisting of five parts: (I) demographic data, (II) subjective self-ratings on competence in ketosis home management, (III) objective assessment of competence in ketosis home management using a standardized clinical case scenario consisting of 10 management steps, in which participants were asked to describe the actions they would take to prevent DKA, and (IV) practical demonstrations to objectively assess skills in (IVa) urine dipstick self-testing and (IVb) insulin administration, (V) household availability of (Va) urine dipsticks and (Vb) insulin cartridges. Results: (I) We enrolled 61 adolescents and 79 caregivers. (II) Competence in ketosis home management was subjectively self-rated as good to very good. (III) Adolescents reported 4 (median; Q25/Q75 3/5) and caregivers 5 (4/5) of 10 management steps. Never self-testing ketone levels was reported by 33% of adolescents and 11% of caregivers. (IVa) At least one handling error occurred in 100% of adolescents’ and in 98% of caregivers’ practical demonstrations of urine dipstick self-testing and in (IVb) 98% of adolescents’ and 98% of caregivers’ insulin administrations. (Va) Altogether urine dipsticks were available in 43% of households, whereas (Vb) insulin cartridges were available in 78% of households. Conclusions: Our results demonstrate a mismatch between challenges in ketosis home management and high subjective self-ratings.

This research aims to: 1) study the components and indicators of internal supervision in educational institutions to enhance the learning management competencies of secondary school teachers; 2) examine the current situation, desired conditions, and essential needs of internal supervision in educational institutions for the development of these competencies; and 3) explore guidelines for internal supervision in educational institutions to improve the learning management skills of secondary school teachersThe research is divided into three phases: Phase 1: Synthesis of components and indicators of internal supervision to enhance the learning management competencies of secondary school teachers, based on the study of relevant concepts, theories, documents, and research. The appropriateness of components and indicators was assessed by seven experts. Phase 2: Surveying the current situation, desired conditions, and analyzing essential needs. The sample group size was determined according to the Krejcie and Morgan table, consisting of 385 secondary school administrators and teachers selected through multistage sampling. The tool used was a questionnaire, with reliability measured by Cronbach&amp;rsquo;s alpha coefficient. Phase 3: Identifying guidelines for internal supervision in educational institutions to enhance the learning management competencies of secondary school teachers, based on the study of three exemplary educational institutions with outstanding performance and data were analyzed through content analysis. Research Findings 1) Components and Indicators of Internal Supervision: The components and indicators for internal supervision in educational institutions to enhance the learning management competencies of secondary school teachers include: Planning for supervision, Implementation of supervision, Evaluation of supervision, Reflection on supervision, Improvement of supervision practices 2) Current and Desired Conditions: The overall current practice of internal supervision is at a moderate level, while the desired conditions are rated at the highest level. Specifically, the area of reflection on supervision shows the highest essential needs. 3) Guidelines for Internal Supervision: The proposed guidelines for internal supervision in educational institutions to enhance the learning management competencies of secondary school teachers involve integrating Professional Learning Community (PLC) processes with internal supervision in all areas, including planning, implementation, evaluation, reflection, and improvement of supervision. Additionally, for planning and implementing supervision, the guidelines include: Promoting the use of media, innovations, and digital technologies, Providing sufficient resources for operations, Continuous monitoring and supervision by school administrators.

University educational management involves the application of specific strategies, tactics, and competencies by its leaders. The purpose of this study was to evaluate the educational management competencies of graduate program coordinators in the Northern region of Mexico. A quantitative, exploratory-descriptive, and cross-sectional study was conducted. The sample consisted of 66 participants who, through the Self-Assessment Questionnaire of Educational Management Competencies for Academic Program Directors (“Cuestionario de Autoevaluación de Competencias en Gestión Educativa para Directivos Académicos de Posgrado, CACGEDA-P”), reported their level of competency evaluated. The results show that, overall, 59.1% of participants demonstrated a high level of competency. The findings provide an initial comprehensive characterization of this group of academic administrators, highlighting both their relevant strengths and their substantial areas for improvement.

The International Organization for Standardization (ISO) 15189 standard is essential for quality management in clinical laboratories, yet its integration into undergraduate medical laboratory technology education remains limited. This study aimed to evaluate the impact of a simulated laboratory teaching model based on the ISO 15189 standard on the quality management competencies of undergraduate interns and to compare it with traditional teaching methods. A parallel-group, randomized controlled trial was conducted in the Department of Clinical Laboratory at the Second People's Hospital of Hunan Province (Brain Hospital of Hunan Province). A total of 60 undergraduate medical laboratory technology students scheduled to commence their clinical clerkship between July 2023 and May 2025 were enrolled and randomly allocated to an intervention group (n = 30) or a control group (n = 30). The intervention group received simulated laboratory teaching based on the ISO 15189 standard, including the construction of a quality management system and full-process simulated accreditation practice. The control group received traditional clinical clerkship teaching. Primary outcome measures were comprehensive assessment scores at the end of the internship (covering pre-examination, intra-examination, and post-examination quality control knowledge) and problem-solving ability scores in quality management roles. Secondary outcome measures included understanding of the quality management system, quality improvement awareness, and teaching satisfaction. Compared with the control group, the intervention group showed significantly higher scores in pre-examination quality control, intra-examination quality control, post-examination quality control, understanding of the quality management system, quality improvement awareness, and problem-solving ability in quality management roles (P < .01). Teaching feedback questionnaires also indicated higher satisfaction with the teaching model in the intervention group. For undergraduate medical laboratory technology interns, the simulated laboratory teaching model based on the ISO 15189 standard is significantly more effective than traditional teaching methods in enhancing their knowledge, skills, and competency in quality management.

Urinary tract obstruction, resulting from various etiologies, is a significant clinical condition associated with substantial morbidity, including life-threatening sepsis and acute kidney injury. Prompt intervention for decompression via ureteral stenting or percutaneous nephrostomy is paramount. This study aimed to assess the practice patterns of urologists in Türkiye concerning percutaneous nephrostomy and to highlight its integral role within urological clinical practice. A cross-sectional study was conducted between 7th May 2022 and 31st May 2023 following institutional ethics committee approval. A 13-item questionnaire was distributed to 131 urologists of various academic ranks. The data were analyzed using the chi-square test. Of the respondents, 71% (n=92) reported competency in performing percutaneous nephrostomy, while 29% (n=38) indicated they could not. Regarding the ideal provider for percutaneous nephrostomy, 31% (n=41) advocated for urologists, 11% (n=14) for interventional radiologists, and 58% (n=76) supported a collaborative approach between both specialties. When asked about institutional practice patterns, 11% (n=14) reported that percutaneous nephrostomy was not performed, 38% (n=50) noted it was performed by urologists, 24% (n=31) by interventional radiologists, and 28% (n=36) by both specialties. Notably, 55% of urologists who do not perform percutaneous nephrostomy, regardless of academic rank, cited malpractice concerns as the primary reason. Percutaneous nephrostomy remains a fundamental procedure in urological clinical practice. Our findings suggest that its inclusion in urology residency training curricula is vital to ensure urologists retain their competency in percutaneous nephrostomy management. Comprehensive training and proficiency in percutaneous nephrostomy should be a core component of urology residency programs.

Deficient palliative care coverage and nursing training in Ecuador warrant examining self-efficacy to inform education strategies and strengthen equitable services. To examine Ecuadorian nurses' self-efficacy in Palliative Care. A sequential explanatory mixed-methods study was conducted. Convenience samples of nurses completed the Self-Efficacy in Palliative Care Questionnaire and participated in online semi-structured interviews. Descriptive statistics were used for quantitative data. A side-by-side joint display supported integration. 497 nurses completed the questionnaire (90.4% female; 11.47 years of experience). Teamwork scored highest, while communication scored lowest. Eighteen nurses were interviewed (88.8% female; 11.5 years of experience). Participants reported communication difficulties related to emotions, prognosis, denial, collusion of silence and paediatric cases. They expressed strong confidence in pain management but more difficulty with agitation and dyspnoea. Spiritual care was mainly understood as facilitating access to religious figures. Although teamwork was perceived positively, tensions with physicians and an excessive focus on physical aspects were noted. Quantitative and qualitative findings aligned overall, with dissonances regarding psychological and social communication. Strengthening communication and comprehensive patient management competencies, as well as addressing interdisciplinary tensions, is necessary to improve and consolidate Palliative Care in Ecuador. This study adhered to EQUATOR guidelines and used COREQ for qualitative reporting. No patient or public contribution.