Parenting stress among clinical nurses has been associated with turnover-related outcomes. For many nurses, critical periods of career development and accumulated clinical responsibility overlap with reproductive and early parenting years. Features of nursing work may shape parenting stress through demands related to scheduling, workload, and limited flexibility. Integrative literature review. An integrative literature review was conducted following the methodological framework of Whittemore and Knafl. The final searches across three databases (CINAHL Complete, Medline, and Embase) were completed on May 14, 2026. Eligible articles were published in English, addressed parenting stress, and, when empirical, included nurses as a distinct population. Reporting followed PRISMA guidelines. Eight articles met all inclusion criteria. Countries of origin included South Korea, Turkey, and China. Approximately 1667 nurse-parent participants were represented across the included studies. Main themes included as follows: (1) Work-Family Role Conflict and Parenting Stress, (2) Parenting Stress Across Career and Family Life Stages, (3) Parenting Stress and Nurse Workforce Outcomes, and (4) Organizational and Structural Contributors to Parenting Stress. Parenting stress appears to be a relevant nursing workforce issue shaped by structural conditions of practice. The structure and demands of patient care may intensify parenting stress. Additional research is needed to examine the effects of parenting stress in clinical nurses and the implications for nurse retention. Organizational and policy-level interventions (including family-friendly scheduling, accessible childcare, and structured peer support programs) may support workforce sustainability among nurse-parents.

Antenatal risk assessment and classification in maternity care: An integrative review.

This study analyzed the role of the Military Police of the State of Pará (PMPA) in preventing femicide, focusing on social defense policies aimed at protecting women in situations of vulnerability. It is an integrative literature review, with a qualitative, exploratory, and descriptive approach, conducted on the Google Scholar, SciELO, and CAPES databases, covering the period from 2015 to 2026, complemented by documentary research on normative and institutional frameworks. The final corpus comprised 64 sources, including 48 scientific works and 16 normative and institutional documents, analyzed through thematic analysis organized into three axes: theoretical and normative foundations; preventive strategies and actions; and challenges and potentialities. The results showed that femicide is a multifactorial phenomenon, in which individual conditions, abusive relationships, and contexts of deprivation overlap, requiring state responses that go beyond a strictly repressive logic. The PMPA was found to develop institutionalized preventive strategies, notably the Maria da Penha Patrol, the monitoring of urgent protective measures, the use of risk assessment tools, and the standardization of Standard Operating Procedures aimed at preventing revictimization. An alignment was also identified between the profile of the women assisted and the risk factors described in the literature, as well as a relevant protective impact of these actions. However, the effectiveness of these policies remains conditioned by structural challenges, such as insufficient specialized personnel, logistical limitations arising from the state's territorial dimensions, and weak intersectoral integration, especially in riverside and hard-to-reach areas. Technology-facilitated violence against women was also identified as a design gap not yet incorporated into the protocols. It is concluded that the PMPA plays a strategic role in protecting women, although its consolidation depends on expanding resources, strengthening local networks, and ensuring the continuity of social defense policies.

The evolution of the digital fashion sector has transformed consumption patterns, particularly among Generation Z. Fast fashion has emerged as a well-known business model characterized by affordable trendy products and extremely rapid production cycles. This phenomenon has triggered more impulsive consumer behavior and a heightened “Fear of Missing Out” (FOMO) among young buyers. However, growing awareness of environmental issues, labor exploitation, and manipulative marketing strategies has given rise to a new phenomenon known as “de-influencing.” This study aims to explore how de-influencing has affected Generation Z’s purchasing behavior, shifting them from fast fashion culture toward more critical and conscious consumption patterns. The study employs a qualitative method by integrating literature review and analyzing various academic articles, journals, and online sources related to consumer behavior, social media, fast fashion, and de-influencing. The findings indicate that social media serves as a dominant factor shaping Generation Z consumer behavior, both through influencer impact and digital platform algorithms. Nevertheless, increasing digital literacy and social awareness encourage Generation Z to question overconsumption culture and place greater value on sustainability, brand transparency, and long-term product utility. The phenomenon of de-influencing represents a form of resistance to consumerist culture while also reflecting this broader behavioral shift.

Medication Adherence in Pediatric Sickle Cell Disease and Hematopoietic Stem Cell Transplantation: An Integrative Review of Literature.

The sustained well-being of the nurse practitioner (NP) workforce is threatened by pervasive role ambiguity. This ambiguity is frequently cited as a barrier to successful professional integration and practice. Although existing literature acknowledges this issue, it lacks a formal definition within the context of NP practice. This omission prevents targeted evaluation of its true impacts and the development of effective interventions. The purpose of this article is to present a concept analysis of role ambiguity within the NP context. Rodgers' evolutionary concept analysis was used. A targeted integrative literature review was conducted across PubMed, CINAHL, and Scopus. This process resulted in 29 articles selected for thematic analysis. The analysis revealed NP role ambiguity manifests as both an internal professional identity conflict and an externally imposed issue driven by systemic barriers. The derived working definition is a state of confusion or lack of clarity regarding the practice authority, scope of practice, abilities, and educational preparation of NPs experienced not only by NPs themselves but also by health care consumers, other health care staff, administrators, and the public ultimately leading to decreased job satisfaction, difficulties in professional identity formation, and the marginalization of NPs. Key attributes include conflict over scope of practice and the discrepancy between the anticipated and actual NP role. Antecedents span legal, organizational, and financial barriers, with consequences such as underutilization and burnout. These findings require recognizing NP role ambiguity as an externally imposed systemic challenge that generates internal conflict. Nurse practitioners should leverage this clarified definition to advocate for broader professional recognition and guide the implementation of external strategies, such as targeted education campaigns and policy advocacy, to support professional sustainability.

Employing the mixed-method approach of an integrative literature review, a study of an African university press and key informant interviews, this study critically evaluates the relationship between knowledge production and scholarly publishing in postcolonial Africa. Drawing on Munoz’s rationality of tradition as a conceptual framework, this paper argues that academic publishing houses in African universities are caught between two major predicaments. The first is the Western-centric hegemony on knowledge production, which too often considers knowledge produced in the Global South inferior. The second is the difficulty publishing houses in African universities face in producing knowledge that aligns with the highest global standards. This paper argues that funding of university presses alone cannot dismantle postcolonial knowledge dominion. Rather, to address both dilemmas, a nuanced approach that considers the many complexities of Africa’s knowledge landscape is needed. This approach will enable university presses to attain international best practices in knowledge production while deflating the inferiority label.

Understanding toxic behaviors in the esports environment: an integrative review and future research directions

Albiflorin, a monoterpenoid glycoside extracted from Paeonia lactiflora, has garnered growing interest in both traditional Chinese medicine and contemporary pharmacological research owing to its extensive therapeutic potential. However, a systematic understanding of its pharmacological activities and pharmacokinetic characteristics profile is still lacking. An integrative literature review was conducted using major biomedical databases to collect experimental and pharmacokinetic evidence related to albiflorin. The data were synthesized to evaluate their pharmacological activities, signaling mechanisms, and absorption, distribution, metabolism, and excretion (ADME) behavior. Albiflorin demonstrated broad pharmacological effects, including anti-inflammatory, neuroprotective, psychotropic, antitumor, metabolic modulatory, bone-protective, cardiovascular, analgesic, and hepatoprotective activities. These pharmacological functions were associated with coordinated modulation of key signaling cascades, notably NF-κB/MAPK and PI3K/AKT. Pharmacokinetic investigations indicated rapid absorption and extensive tissue distribution, while oral bioavailability remained suboptimal but amenable to formulation-based enhancement. Albiflorin represents a promising multifunctional natural compound with wide therapeutic prospects. Further mechanistic studies, pharmaceutical optimization, and clinical validation are required to advance its clinical translational application.

Most people with dementia reside in the community and are cared for by family members. Family caregivers play an essential role in supporting their loved ones with dementia and require adequate education and support to address their care needs. In recent years, there has been growing interest in the use of chatbot technologies in health care, particularly to provide education and support for caregivers. However, evidence on the development, use, and effectiveness of these technologies in dementia care remains limited. This systematic integrative review aims to synthesize evidence on chatbot applications as an educational and supportive tool for family caregivers of people with dementia. A systematic integrative literature review will be conducted following a validated framework. The findings will be reported in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search strategy will be structured around 3 broad concepts: "dementia," "caregiver," and "chatbot applications." Full-text articles based on empirical studies published in English from inception to 2026 that address the design, development, or evaluation of chatbot applications for family caregivers of people with dementia will be included. Editorials, study protocols, review articles, opinion and perspective papers, technical notes, and non-English publications will be excluded. Covidence software will be used to manage study screening. At least 2 independent reviewers will screen titles, abstracts, and full texts and extract data using a pretested data extraction form. Methodological quality will be assessed using Mixed Methods Appraisal Tool (version 2018), and data relevance will be evaluated using a 2-point scale (high or low). The literature search will commence in May 2026, and the findings are expected to be published as a systematic integrative review, with submission planned for January 2027. This systematic integrative review aims to synthesize evidence from qualitative, quantitative, and mixed methods studies to provide a comprehensive understanding of how chatbot interventions are conceptualized, developed, and evaluated within dementia caregiving contexts. In addition, this review will identify key barriers and challenges as well as ethical and safety concerns associated with the design, development, and implementation of chatbot applications for family caregivers of people with dementia. PROSPERO CRD420261288076; https://www.crd.york.ac.uk/PROSPERO/view/CRD420261288076. PRR1-10.2196/91741.

Population aging, the increase in chronic diseases, and the continuous use of medications have expanded the importance of polypharmacy in the care of older adults, especially in Primary Health Care and the Family Health Strategy. This study aimed to analyze the evidence available in the literature on polypharmacy among older adults in this context. This is an integrative literature review, guided by the question: what evidence does the literature present on polypharmacy among older adults in the Family Health Strategy? The search was conducted in scientific databases and sources, especially the Virtual Health Library, SciELO, PubMed, and Google Scholar. Original full-text articles that directly addressed polypharmacy or polymedication among older adults in the context of the Family Health Strategy were included. After applying the eligibility criteria, the final corpus consisted of five studies. The results showed that the topic has mainly been discussed in relation to the occurrence of polypharmacy, associated factors, and repercussions for care. Quantitative studies predominated, especially cross-sectional studies, in addition to one qualitative study. The analysis allowed the identification of four central themes: older adults as the main focus of the studies; the manifestation of polypharmacy in this context; associated factors and situations of greater frailty; and its repercussions for primary care. It is concluded that polypharmacy among older adults in the Family Health Strategy is a relevant and multifactorial phenomenon related to the complexity of longitudinal care, requiring careful follow-up and thorough evaluation of medication use.

BackgroundSurgical complications pose a significant risk for older adults (60+ years old) undergoing elective surgery, highlighting the need for interventions to prevent harm. Pre-surgical optimization has been postulated as one method to promote health outcomes before elective surgeries. Creative approaches to pre-surgical optimization are necessary, especially given the shortage of health-care providers. This review examines the existing literature on critical elements of pre-surgical optimization that older adults can effectively self-manage as well as the best methods to design resources to empower older adults to self-optimize prior to surgery.MethodsAn integrative review was conducted by searching literature indexed in Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, and Scopus.ResultsTwo themes emerged from the analysis of 22 empirical studies: 1) critical elements of pre-surgical optimization for older adults, and 2) effective strategies for educating and preparing older adults for surgery. Additionally, six subthemes were identified.ConclusionEvidence-informed self-guided pre-surgical optimization resources for older adults should be developed to prevent surgical complications among older adults.

Compounding pharmacies have gained prominence in the cosmetic market due to the growing demand for personalized treatments focused on hair health. In this context, customized anti-dandruff shampoos stand out because they allow the development of specific formulations according to the individual needs of each consumer, considering factors such as hair type, scalp oiliness, sensitivity, and seborrheic dermatitis. The present study aimed to demonstrate the relevance of compounding pharmacies in the development of personalized anti-dandruff shampoos, emphasizing therapeutic benefits, formulation quality, and the role of the compounding pharmacist. This study consists of an integrative literature review with a qualitative and descriptive approach, carried out through searches in the SciELO, PubMed, and Google Scholar databases, using descriptors related to compounding pharmacies, compounded cosmetics, and anti-dandruff shampoos. The results showed that the personalization of hair formulations significantly contributes to greater therapeutic efficacy, safety, and treatment adherence. In addition, the analyzed studies highlighted the importance of microbiological and physicochemical quality control of compounded cosmetics, as well as the essential role of pharmacists in patient guidance and monitoring. It is concluded that personalized anti-dandruff shampoos developed in compounding pharmacies represent an effective and safe alternative for the treatment of scalp disorders, promoting clinical benefits, improved self-esteem, and better quality of life for consumers.

Retention of CPR skill and knowledge among nurses and nursing students following BLS training - An integrative literature review.

PurposeTo describe a Middle Range Theory (MRT) capable of conceptualizing and clarifying Excessive Caregiving Burden (ECB), based on Betty Neuman's Systems Model theory, supporting the validation of the phenomenon as a nursing diagnosis present in the NANDA-I classification.Data SourcesThe MRT was developed based on the theoretical-causal validity method by Lopes & Silva, following steps: (1) definition of the approach for constructing the MRT, (2) definition of the main concepts, (3) development of the pictorial diagram, (4) construction of propositions and (5) establishment of causal rela tionships and evidence for practice. The construction of a predictive theory was anchored in Betty Neuman's Systems Model and facilitated by integrative and systematic literature reviews on clinical indicators, etiological factors, and risk conditions.Data SynthesisThe theory identifies 26 clinical indicators, 23 related factors, seven populations at risk, and five associated conditions for Excessive Caregiving Burden. The pictogram represents the dynamic interaction of concepts around intrapersonal, interpersonal, and extrapersonal stressors and the caregiver's lines of defense, illustrating the underlying causal mechanisms of ECB. Sixteen theoretical propositions were established, relating related factors and observable clinical manifestations.ConclusionsThe predictive MRT for Excessive Caregiving Burden advances nursing knowledge by defining the causal mechanisms around caregivers, which are affected by stressors influencing the manifestation of this undesired human response, supporting the diagnostic structure of Excessive Caregiving Burden and proposing its refinement as a nursing diagnosis in NANDA-I.Implications for Nursing PracticeThe results will provide nurses with a conceptual and practical tool to identify the manifestation of Excessive Caregiving Burden in caregivers, recognize clinical indicators or etiological factors, and implement preventive and therapeutic interventions. It strengthens the scientific basis of nursing practice, improves caregivers' health outcomes, and contributes to advancing standardized nursing language through the refinement of this diagnosis present in NANDA-I.

Hormonal regulation in women plays a fundamental role not only in reproductive physiology, but also in metabolic and cardiovascular homeostasis throughout life. Recent scientific evidence demonstrates that endocrine transitions and hormonal disorders influence endothelial function, lipid metabolism, insulin sensitivity, inflammatory pathways, adipose tissue distribution, and long-term cardiovascular risk. This review aimed to analyze the systemic effects of female hormonal regulation beyond reproduction, emphasizing its relationship with metabolic and cardiovascular health through an interdisciplinary perspective integrating gynecology, endocrinology, cardiology, and public health. A narrative and integrative literature review methodology was employed using peer-reviewed scientific publications indexed in internationally recognized databases, including PubMed, Scopus, ScienceDirect, and Google Scholar. Contemporary evidence related to menopause, polycystic ovary syndrome, hypertensive disorders of pregnancy, hormonal therapies, endothelial dysfunction, insulin resistance, and cardiometabolic disease was analyzed and synthesized. The reviewed evidence demonstrated that menopause is strongly associated with endothelial dysfunction, visceral adiposity, dyslipidemia, insulin resistance, and increased cardiovascular risk. Polycystic ovary syndrome was identified as a multisystemic endocrine-metabolic disorder closely linked to obesity, chronic inflammation, hyperandrogenism, and future risk of type 2 diabetes mellitus. Additionally, pregnancy-related hypertensive disorders such as preeclampsia and gestational hypertension were associated with elevated long-term risk of chronic hypertension, ischemic heart disease, and cerebrovascular disease. Hormonal therapies and contraceptive methods demonstrated both beneficial vascular effects and potential thrombotic risks depending on patient characteristics and individualized cardiovascular profiles.

Triage is a critical process for patient prioritisation in emergency departments (EDs) that aims to rapidly allocate patients to the appropriate level of emergency care commensurate with clinical urgency. Triage completion is expected within two to five minutes while ensuring patient safety. The purpose of this review is to identify the facilitators and barriers to triage efficiency in EDs and provide an overview of how these factors impact the triage process. An integrative literature review was conducted with a structured search across six databases, including CINAHL, Embase, Medline, Scopus, ProQuest, and PubMed. Twenty studies met the inclusion criteria and were narratively synthesised. Factors affecting triage efficiency were grouped under four themes. Process-related factors such as workflow designs, electronic triage support decision tools, "quick look" triage approaches, and system inefficiencies; nurse-related factors like experience, educational attainment, cognitive approach, and fatigue; environmental and system-related pressures such as interruptions, high patient volume, overcrowding, and availability of adequate triage spaces and equipment; and patient factors, including patient complexity, all shaped triage efficiency. Triage efficiency is a dynamic and context-sensitive outcome shaped by multiple factors. Some factors are modifiable, and further studies are needed to explore targeted interventions and their impact on triage efficiency in emergency care.

The relationship between workplace ostracism and counterproductive knowledge behavior: An integrative literature review using transaction model of stress and coping

To systematically analyse international empirical literature and establish a comprehensive understanding of the push and pull factors influencing retention and turnover among mid-career nurses. An integrative review. PubMed, Web of Science, Scopus, EMBASE (Ovid), and CINAHL (EBSCO) were searched for studies published between January 2001 and November 2024. An integrative literature review was conducted following the five-step process outlined by Whittemore and Knafl. Articles were screened by title, abstract, and full text based on predefined inclusion and exclusion criteria. The quality of eligible studies was assessed using the Mixed Methods Appraisal Tool (MMAT). Data were extracted and synthesised narratively, and the findings were presented according to the socio-ecological framework. A total of 1930 studies were identified, with 14 included for analysis: 10 qualitative, 3 quantitative, and 1 mixed-methods study. Guided by the socio-ecological framework, four themes and 10 subthemes emerged: (1) Intrapersonal (professional knowledge/skills, health issues, work-family balance); (2) Interpersonal (professional collaborative relationships, supervisor support); (3) Organisational (organisational characteristics, work characteristics, career development); and (4) Societal (salary/benefits, Social/governmental recognition). This review reveals the heterogeneity of research on this topic and confirms previous findings. It identifies certain push-and-pull factors common to nurses across all stages of their careers. However, mid-career nurses face unique challenges, including more complex healthcare demands, declining health status, growing family caregiving responsibilities, unclear organisational roles, underutilisation of professional skills, career stagnation, and limitations on salary growth. These findings highlight the need for tailored retention strategies for mid-career nurses. A "one-size-fits-all" retention strategy does not meet the needs of all nurses. To improve nurse retention rates, it is essential to address the shifting demands and priorities that arise as nurses reassess and transition through different career stages. For mid-career nurses, acknowledging and valuing their expertise and capabilities, providing sufficient resources, and fostering a supportive work environment that promotes career development may be effective strategies for retaining these experienced professionals. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. No Patient or Public Contribution.

The purpose of this integrative literature review was to synthesize quantitative and qualitative evidence describing the impact of cultural perceptions on diabetes self-care behaviors among Filipino American adults with type 2 diabetes (T2DM), identifying knowledge gaps and generating practice implications for diabetes care and education specialists. Using Whittemore and Knafl's integrative review framework, 4 databases (CINAHL, PubMed, Medline, and ScienceDirect) were searched for English-language studies published from 2000 to 2025. Inclusion criteria included empirical studies examining cultural factors, classified as (1) family-centered values (e.g., bayanihan, pakikisama), (2) traditional food practices, (3) spirituality and fatalism, (4) acculturation and colonial mentality, and (5) community support networks and at least 1 ADCES7 self-care behavior in Filipino American adults with T2DM. Methodological quality was evaluated using the Johns Hopkins evidence-based practice tool. Data were extracted into standardized matrices and analyzed through constant comparative analysis. Nine studies (6 quantitative, 3 qualitative) identified 5 cultural domains that facilitated or hindered ADCES7 behaviors, including healthy eating, medication adherence, and blood glucose monitoring. Evidence strength ranged from Level II to Level III. Diabetes care and education specialists must assess these 5 cultural domains, incorporating family involvement, culturally appropriate nutrition counseling, spiritual considerations, and community-based support, to enhance ADCES7 self-care behaviors.