Missed nursing care in community-based health care: A scoping review.

Nursing care in a patient with ischemic stroke undergoing endovascular thrombectomy: A case report

This study aimed to identify the factors associated with nursing profession self-efficacy among newly graduated nurses. This descriptive cross-sectional study adhered to the STROBE guidelines. This descriptive study was conducted with 162 newly graduated nurses who had less than 1 year of clinical experience. Data were collected using both online and offline recruitment strategies from March 8 to April 23, 2025. Validated instruments were used to measure resilience, missed nursing care, nursing work environment and nursing profession self-efficacy. Data were analysed using descriptive statistics, t-tests, ANOVA, Pearson's correlation and hierarchical regression analysis. Nursing profession self-efficacy showed significant positive correlations with resilience and the nursing work environment, and a negative correlation with missed nursing care. Resilience and the nursing work environment were identified as significant factors associated with nursing profession self-efficacy. This study highlights the importance of strengthening resilience and improving the nursing work environment to enhance nursing profession self-efficacy among newly graduated nurses. To enhance self-efficacy, emotional and educational support should be strengthened, and improvements in the work environment are needed to promote patient safety and the quality of nursing care. Nursing managers and educators should consider strategies to strengthen resilience and improve the nursing work environment for newly graduated nurses. Structured education, job training, mentoring, emotional support and strengthened preceptorship programs may support professional role adaptation, reduce turnover intention and contribute to patient safety and nursing care quality.

Professional values are fundamental determinants of nursing care quality and ethical practice. Self-compassion has emerged as an important psychological resource that may support nurses' well-being and caregiving performance, particularly in demanding environments such as intensive care units. However, limited evidence exists regarding the relationships among professional values, self-compassion and caring behaviours in intensive care nurses. To examine the relationships between intensive care nurses' professional values, self-compassion and caring behaviours and to determine the mediating role of self-compassion in the relationship between professional values and caring behaviours. A descriptive and correlational study was conducted in the intensive care units of a university hospital in eastern Türkiye between November 2025 and February 2026. Data were collected using the Personal Information Form, Nurses' Professional Values Scale, Short Form Self-Compassion Scale, and Caring Behaviors Inventory. Descriptive statistics, Pearson correlation analysis, hierarchical regression analysis, and PROCESS Macro (Model 4) mediation analysis were used. A total of 134 intensive care nurses participated in the study. Professional values and caring behaviours were high (149.91 ± 12.02 and 167.32 ± 16.73, respectively), whereas self-compassion was moderate (36.66 ± 8.41). Significant positive correlations were found among professional values, self-compassion, and caring behaviours (p < 0.01). Professional values significantly predicted self-compassion (β = 0.418) and caring behaviours (β = 0.580), while self-compassion significantly predicted caring behaviours (β = 0.222). After controlling for gender, income status, unit of work, and number of patients cared for, self-compassion partially mediated the relationship between professional values and caring behaviours (indirect effect = 0.129; 95% CI: 0.036-0.223). The model explained 53% of the variance in caring behaviours. Professional values influence intensive care nurses' caring behaviours both directly and indirectly through self-compassion. Self-compassion appears to be an important psychological mechanism that strengthens the positive effect of professional values on caring behaviours. Enhancing self-compassion may contribute to improving nursing care quality in intensive care settings. Interventions aimed at strengthening self-compassion and educational programmes that promote professional values may enhance caring behaviours among intensive care nurses and improve the quality of patient care.

Many patient care tasks can be safely performed by nonlicensed personnel, allowing licensed nursing staff to focus on care that requires specific clinical expertise. A shortage of nurses and patient care technicians (PCTs) often leads to missed essential nursing care, reduced job satisfaction, poorer outcomes, and increased costs. The purpose of this study was to evaluate whether a newly established staffing model, which paired one nurse and one PCT for every five patients, markedly increasing the number of PCTs, could enhance patient and staff outcomes while also lowering costs. A project proposal was developed and approved by leadership that included estimates of cost savings after the changes in staffing ratios. The study period was from July 1, 2024, to December 31, 2024. Data analysis took place from January 1, 2025, to February 28, 2025. After discussions with leadership, the acute care medical unit transitioned from a 1:4 RN-to-patient ratio and a 1:10 to 1:12 PCT-to-patient ratio to a 1:5 RN-to-patient ratio and 1:5 PCT-to-patient ratio. A MISSCARE Survey, which evaluates perceptions of and reasons for missed nursing care, as well as perceptions of a unit's working environment (teamwork), was distributed to all unit staff members before implementation of the staffing change and again six months after implementation. Quantitative data included MISSCARE Survey responses, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) nursing communication scores, and bathing compliance, as well as the financial calculations (contingency labor hours and unit overtime and vacancy rates). Data were analyzed using descriptive statistics and Mann-Whitney tests. Of 51 eligible staff members, 26 completed the baseline survey and 32 completed the postimplementation survey. Of the 24 missed care items in the survey, statistically significant improvements were seen in six: complete documentation, meal setup, toileting, bathing and skin care, feeding patients, and patient teaching and education. Additionally, statistically significant improvements were observed in HCAHPS nursing communication scores and unit bathing compliance. All cost-related outcomes also improved significantly, including reduced contingency labor hours, decreased RN/PCT vacancy rate, and decreased overtime, resulting in a total of $453,228 in annual departmental savings. Meaningful improvements in care delivery, patient outcomes, staff experience, and unit costs were observed on this acute care medical unit after the creation of a more balanced staffing model through adjustments in the RN and PCT staffing ratios. These findings support expansion and scaling of the new model to gather longitudinal data on its potential impact.

Unplanned extubations are adverse events with multifactorial causes, involving both patient characteristics and organizational features in Paediatric Intensive Care Units (PICUs). To identify the main clinical and contextual determinants associated with unplanned extubations in PICU patients. We conducted a case-control retrospective observational study at a paediatric hospital in Eastern Andalucia (Spain). Cases were patients who experienced an unplanned extubation, and controls were those who did not during the same period. A total of 121 active cases and 275 controls were included, yielding a rate of 5.07 events per 100 ventilated patients. For the 2902 invasively ventilated children, 147 unplanned extubations occurred in 121 children (4.17% of children experienced at least one event). Unplanned extubations occurred more frequently in patients receiving assisted ventilation (OR = 2.52; 95% CI: 1.56-4.07). The mean additional length of stay in the PICU for cases was 7.5 days. Independent predictors for unplanned extubations included male sex (OR = 0.87; 95% CI: 0.47-1.63), older age (OR = 1.01; 95% CI: 0.99-1.02), use of assisted-spontaneous ventilatory modes (OR = 2.47; 95% CI: 1.18-5.19), lower doses of midazolam (OR = 24.28; 95% CI: 1.57-11.62), and nurse overallocation (OR = 2.05; 95% CI: 1.19-3.53). Unplanned extubations in PICU are influenced by both clinical factors and organizational aspects of care. Notably, most predictors identified (e.g., sedation practices, nurse staffing) are modifiable, indicating the potential for targeted interventions to reduce this adverse event. Preventing unplanned extubations is critical for safeguarding paediatric patients. By optimizing nursing ratios, sedation regimens, and care protocols, PICUs can reduce the incidence of accidental extubations, thereby improving patient outcomes and minimizing prolonged lengths of stay. These findings should be used by healthcare managers to systematically evaluate the consequences of a severe adverse effect such as unplanned extubations (UE) and introduce quality improvement actions to minimize the consequences on patient safety and PICU outcomes.

Characterizing nursing home care team communication via text messaging: A social network analysis.

Retractions in nursing are often framed as isolated instances of author misconduct or editorial failure. Drawing on recent longitudinal analysis of retracted nursing articles and the Journal Systems Framework (JSF), this Commentary argues that retractions are better understood as system-level signals reflecting differences in editorial capacity, governance, and infrastructure across journal systems. Between 1997 and 2022, 123 nursing articles were retracted, with persistent concerns related to ethical violations, variability in retraction notice quality, delayed corrective action, and continued post-retraction citation. Applying the JSF highlights how corrective capacity varies across journal systems, shaping the timeliness, transparency, visibility, and downstream amplification of retraction practices. High-profile retractions in flagship journals may reflect greater corrective capacity rather than uniquely severe ethical failure. Interpreting retractions as indicators of system stress, rather than moral anomalies, shifts attention from individual blame toward strengthening editorial infrastructure. A systems-aware approach positions nursing scholarship to improve transparency, resilience, and trust as publication volume and complexity continue to grow. Because nursing scholarship informs clinical care, education, and policy, failures in the scholarly record have implications beyond publishing itself. Greater understanding of retractions and corrective editorial processes can help strengthen trust in evidence used to guide nursing and health care practice.

Social support and emotion regulation self-efficacy in nursing staff during public health emergencies: The mediating role of positive affect.

A healthy clinical environment enhances nursing students' learning, safety, recruitment, and caring skills. To reduce first-day stress and promote students' sense of belonging, an intentional orientation program was developed and piloted in eight inpatient units with several schools of nursing. The 3T approach - tour, talk, touch - involved a comprehensive unit tour, patient communication, and hands-on care. Feedback from 25 students showed increased confidence and sense of belonging after the intervention, highlighting informative tours, supportive preceptors, and practical communication as main benefits. The initiative provides an example of a successful orientation that builds student belonging, self-efficacy, and collaboration.

Preterm infants experience frequent stressors that activate the hypothalamic-pituitary-adrenal (HPA) axis. Cortisol can be readily quantified in saliva samples, but sufficient saliva volumes are difficult to collect from preterm infants. We report the development and validation of a novel method to collect saliva using flocked polyester swabs and the application of this method in a study of preterm infants. Saliva samples, collected from adult participants (N = 24), were divided and processed as "standard" aliquots and aliquots absorbed by and extracted from flocked polyester swabs. Cortisol levels in "standard" and "swab" aliquots were compared. We then collected saliva samples from preterm infants (N = 31) using flocked polyester swabs to measure HPA responses to routine, clustered nursing care. Saliva samples were collected from each infant prior to caregiving, 30-min after caregiving, and 60-min after caregiving. Aliquots from the same adult were highly correlated. Sufficient volumes of saliva were extracted from 91 of 93 infant swabs (98%). Changes in cortisol levels from baseline to 30-min and 60-min after caregiving were negatively associated with acute procedural stress, quantified using the Neonatal Infant Stressor Scale. The change in cortisol level from baseline to 60-min after caregiving was negatively associated with caregiving duration. Further research is needed to understand the relationship between caregiving stress exposure and HPA axis responses in preterm infants and to identify the myriad factors that may influence this association. Flocked polyester swabs offer a viable option for the collection of sufficient volumes of saliva to support this research.

Lived experiences of women with interstitial cystitis.

This study aimed to evaluate the ability of three generative artificial intelligence tools (ChatGPT, Gemini and DeepSeek) to generate clinically accurate, comprehensive, and readable nursing care plans aligned with standardised nursing taxonomies (North American Nursing Diagnosis Association International, Nursing Interventions Classification, and Nursing Outcomes Classification). The study further explored variations in tool performance across different nursing specialties. A descriptive comparative design was used. Ten expert-validated clinical scenarios representing five nursing specialties (Fundamentals of Nursing, Medical, Surgical, Paediatric and Psychiatric Nursing) were presented to the three artificial intelligence tools. Each tool responded to four standardised prompts based on the latest North American Nursing Diagnosis Association International, Nursing Interventions Classification and Nursing Outcomes Classification taxonomies. Outputs were assessed for quality, accuracy, completeness and readability by expert evaluators using validated scales. All tools produced nursing care plans of moderate-to-high quality. DeepSeek demonstrated slightly higher accuracy and completeness compared with Gemini and ChatGPT. Surgical nursing scenarios yielded the highest performance, likely reflecting the more protocolised and pathway-driven nature of perioperative care. However, all outputs were incomplete and written at a college-level readability, limiting accessibility for clinical use. Generative artificial intelligence tools can support the production of structured nursing care plans requiring expert review and adaptation, particularly in less standardised clinical domains, but their limitations in completeness and readability indicate they should be regarded only as preliminary drafts requiring expert review and adaptation. The study examined whether generative artificial intelligence can reliably assist in creating nursing care plans. All tools performed moderately well, with DeepSeek showing slight advantages, but outputs were incomplete and difficult to read. Findings are relevant to clinical nurses, educators, healthcare managers and policymakers worldwide who are exploring artificial intelligence in nursing workflows. This study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. This study did not include patient or public involvement in its design, conduct or reporting.

This literature review examines the importance of Evidence-Based Practice (EBP) in nursing, with a focus on its application in Intensive Care Units (ICUs). EBP, through the synthesis of qualitative and quantitative data, promotes evidence-based decision-making, improving care quality, reducing mortality, and limiting complications. The methodology involved a search of the MEDLINE, ELSEVIER, and SCOPUS databases for studies published from 2000 onwards. The findings highlighted key interventions, such as infection prevention, septic shock management, pressure ulcer prevention, and end-of-life care. Additionally, the use of telemedicine and artificial intelligence fosters the integration of EBP into nursing practice. Despite advancements, the review highlights challenges such as lack of time, insufficient training, and limited administrative support. Strategies are proposed, including continuous education, technological support, and strengthening clinical practice through information systems. The findings indicate that the full integration of EBP can lead to significant improvements in care quality and clinical outcomes in ICUs, establishing it as a vital tool for delivering high-level nursing care.

The effect of educational interventions on drug adherence in children with epilepsy and parents: Systematic review and meta-analysis.

Stroke remains a major cause of disability and mortality globally, particularly among older adults in low- and middle-income countries. Integrating the 4Ms framework (What Matters, Medication, Mentation, and Mobility) into nursing-led preventive interventions offers a holistic, person-centered model for promoting healthy aging and mitigating stroke risk. This study evaluated the effectiveness of a nurse-led, age-friendly educational program, grounded in the 4Ms framework, in reducing stroke risk and enhancing health-promoting behaviors among older adults. A randomized controlled trial was conducted with 170 community-dwelling adults (≥ 60 years) attending outpatient clinics in Egypt. Participants were randomized to either a 4Ms-based educational intervention (two structured sessions and materials) or a control group receiving routine care. Outcomes were measured using the Revised Framingham Stroke Risk Profile, the Health-Promoting Lifestyle Profile II, and a stroke prevention practices questionnaire. Post-intervention, the intervention group demonstrated a significant reduction in 10-year stroke risk scores (p<.001) and significant improvements across all health-promoting behavior domains, especially physical activity, nutrition, and stress management (all p<.001). The percentage of participants with good stroke-prevention practices increased from 7.1% to 55.3%. Stroke risk was also inversely correlated with domains like health responsibility and stress management. The nurse-led educational program based on the 4Ms framework was associated with short-term improvements in reducing stroke risk indicators and improving health-promoting behaviors among older adults. Integration of age-friendly principles into preventive nursing care may offer a feasible and holistic approach for supporting healthy ageing in low-resource settings. Longer-term studies remain necessary.Trial RegistrationPan African Clinical Trials Registry (PACTR), registration number PACTR202606898663018. Registration was completed retrospectively.

To identify and synthesise qualitative evidence on nurses' perceptions of reasons for missed nursing care in hospitals. Systematic review of qualitative evidence. An extensive search of all relevant databases was conducted. Study selection, quality assessment, data extraction and meta-aggregation were performed independently by two reviewers according to the JBI guidelines for systematic reviews of qualitative evidence. Confidence in the findings was assessed using the ConQual approach. The electronic databases CINAHL, PubMed, Embase, PsychInfo, and Scopus were searched in January 2024 and repeated in May 2025. Thirty-one studies from hospital settings worldwide were included following critical appraisal, with overall quality rated moderate to high. The studies contributed 168 findings, which were organised into 10 categories and three synthesised findings: Organisational and system-level factors influencing missed nursing care, Teamwork and cultural factors influencing missed nursing care, and Individual nurse- and patient-related factors influencing missed nursing care. Reasons for missed nursing care represent an interplay of systemic, organisational, and individual factors within complex resource-constrained contexts. Healthcare organisations are recommended to implement system-level interventions, rather than relying solely on behaviour-focused solutions. Healthcare leaders should ensure flexible staffing, strong managerial support, and adequate resources to enable fundamental care. Building collaborative, interprofessional cultures that value relational and fundamental care as well as technical tasks is essential, together with education and mentorship that support nurses' decision-making, resilience, and clinical competence. Hospital leaders, policymakers, and nurse managers can use the recommendations to reduce missed nursing care and promote a safe person-centred practice. Implementing systemic changes will improve nurses' working conditions and capacity to deliver comprehensive care, ultimately enhancing patient satisfaction and outcomes. The 'enhancing transparency in reporting the synthesis of qualitative research statement'. No patient or public involvement. The review is registered in the International Prospective Register of Systematic Reviews. PROSPERO CRD42023438198 (https://www.crd.york.ac.uk/PROSPERO/search).

To explore the elements of dignity in interaction and the residents' individual dignity from the viewpoint of staff in long-term care facilities. In-depth interviews were conducted twice with each participant using a hermeneutic phenomenological approach to understand staff experiences and clarify how they understood the meaning of dignity and dignified care. After theme generation, a panel of seven experts reviewed the themes. The previously established framework of the conceptual matrix derived from the residents' perspective was used to verify the applicability of the result. A total of 18 in-depth interviews were conducted with nine staff who worked at long-term care facilities. Mean age of participants was 36.8 years (SD = 5.9; range: 25-43); six were female (66.7%). A total of 944 codes were extracted from the interviews, and four themes were generated: "dignity in relation to family members, friends, society, and other residents"; "dignified direct care"; "dignified care by nursing care facilities and the nursing care system"; and "(residents') dignity developed over the life course." Dignity in interaction and the residents' individual dignity are perceived to be important to care staff. Comparing the elements of dignity extracted from interviews of care staff and those of residents, dignified care is defined by staff with more specific behaviors, responsibilities, and relationships. In long-term care, "dignity developed over the life course" is a subjective and unique dignity that is not easily influenced by others or the environment and is the background of dignity in interaction.

Effects of Simulation-based Preoperative Nursing Care Education on Student Anxiety and Competence in Care: A Randomized Controlled Trial.

In medical and nursing care settings, stroking with speech, which combines physical touch with verbal communication, is extensively employed to enhance positive outcomes, such as anxiety relief and analgesia. Although human-robot interaction studies have demonstrated that robotic stroking with speech elicits stronger positive emotions than stroking or speaking alone, only a few studies have quantitatively verified its analgesic effects. This study investigates whether robotic stroking with speech modulates pain perception. Using the gate control theory as an interpretive framework, we examined whether this multimodal interaction increases pain thresholds and exceeds the effect of stroking only. In an experiment with 37 healthy volunteers, pain thresholds were measured under conditions of No Interaction, Stroking Only, and Stroking with Speech via electrical stimulation. The results revealed that Stroking Only and Stroking with Speech significantly increased the pain thresholds compared with the No Interaction condition. Notably, Stroking with Speech produced a significantly higher threshold than Stroking Only. These findings demonstrate that the benefits of robotic stroking with speech extend to the modulation of pain perception, highlighting its potential as an effective nonpharmacological intervention for pain relief.