The growing demand for transparency about the efficacy of healthcare has accelerated the use of Patient-Reported Outcome Measures (PROMs), but their integration into daily practice is challenging. This observational study describes how the Septoplasty Healthcare Monitor (SHM) addresses these challenges and highlights the benefits of standardised outcome assessments and visualisation for various stakeholders, including physicians and patients. Since 2014, all eligible septoplasty patients have been included in the SHM. Patients are automatically offered the Nasal Obstruction Symptom Evaluation (NOSE) scale and bilateral Visual Analogue Scales (VAS) to assess nasal obstruction before initial consultation and during postoperative visits. Data are entered into a preformatted database and automatically analysed. Real-time results are visually presented on a user-friendly dashboard. A total of 173 patients participated. First, the dashboard provides insights into outcomes on a cohort level. The mean NOSE scores significantly decreased from 68.8 ± 19.0 at baseline to 19.8 ± 22.3 at 12 months (Cohen's d = -1.96). VAS scores improved from 4.6 ± 3.0 (left) and 4.7 ± 2.9 (right) preoperatively to 7.5 ± 2.1 (left) and 7.6 ± 1.7 (right) at 12 months (p < 0.001; d = 0.85; d = 1.05). Second, quality of care is monitored through annual performance metrics and can be improved by critically appraising auto-identified underperforming patients. Third, visualisation of individual PROM symptom-severity scores in relation to peers assists in patient-counselling and shared decision-making. The integration of standardised outcome assessments into daily practice is highly valuable but challenging. The SHM addresses these challenges and offers opportunities to enhance septoplasty care standards.

Noise pollution in intensive care units (ICUs) is a pervasive occupational exposure that may affect nurses' well-being, patient safety and quality of care. To examine ICU nurses' perceptions and experiences of noise pollution and explore associations between perceived noise exposure, well-being, work performance and patient safety. A convergent mixed-methods design was used. Quantitative and qualitative data were collected using structured questionnaires and semi-structured interviews. Qualitative data were analysed using inductive thematic analysis in accordance with GRAMMS guidelines. A total of 60 nurses participated in the quantitative phase, and 13 nurses participated in the qualitative interviews. A substantial proportion of nurses reported that noise often or always increased stress (56.6%, n = 34), restlessness or discomfort (48.3%, n = 29), sleep disturbance (53.3%, n = 32), fatigue or frustration (45.0%, n = 27) and headaches (41.7%, n = 25); 33.3% (n = 20) reported frequent or constant effects on decision-making. Integrated analysis of quantitative and qualitative data identified three overarching themes: (1) the dual role of alarms in patient safety and workflow; (2) alarm burden as a systemic and technical challenge; and (3) strategies for managing alarm-related stress. ICU noise is functionally essential for monitoring and safety yet burdensome for nurses and patients. Individualising alarms for responding staff and using wrist-vibrating bands may reduce noise burden and improve staff well-being and perceived patient outcomes. ICU noise is a modifiable risk to provider health and clinical performance. Practice should move from unit-wide audible alerts to targeted, non-auditory systems (e.g., wrist-vibrating bands) to reduce cognitive load. Clinical leaders must implement 'quiet zones' for high-stakes tasks like medication titration and provide protected rest periods in low-decibel environments to mitigate documented nurse fatigue and sleep disturbance.

Gender Equity in Women's Health and Sexual and Reproductive Health Services in Canada: Perspectives from Providers and Patients.

When Patients' Feelings During Their Hospital Stay Affect Their Level of Experience and Satisfaction with Quality of Care.

Stakeholder voices advance client-centered, culturally responsive occupational therapy research. To describe how engagement of culturally diverse, multilingual, and multidisciplinary stakeholders shaped a project aimed at culturally adapting an evidence-based autism intervention. A mixed-methods design was used to evaluate stakeholder engagement. Quantitative data were used to measure engagement frequency and quality, and qualitative data captured stakeholders' experiences. Engagement activities conducted online and in person at a local community setting. Twenty-five stakeholders-7 parents or caregivers of autistic children, 3 autistic adults, 4 occupational therapy practitioners, 2 psychologists, 3 medical doctors, 3 cultural experts, and 3 teachers-were recruited through snowball sampling. Stakeholders engaged in activities designed to support a project that evaluates two methods of engagement and completes the cultural adaptation of an evidence-based intervention. Activities were guided by the foundational expectations for partnerships as outlined by the Patient-Centered Outcomes Research Institute. The Stakeholder-Centric Engagement Evaluation measured engagement on a Likert scale ranging from 1 (never/poor) to 5 (always/excellent) for how often and how well engagement occurred. Qualitative data were collected using open questions in the survey. Engagement frequency (M = 4.45, SD = 0.24) and quality (M = 4.29, SD = 0.23) were highly rated. Open-ended responses indicated that stakeholders were satisfied with their engagement and interested in additional capacity-building; their feedback shaped the main project in areas including recruitment, retention, data monitoring, and dissemination. Stakeholders rated their research experiences highly. Engagement is vital to integrating lived experiences and cultural context into occupational therapy, advancing health equity through culturally responsive, client-centered care. Plain-Language Summary: The main project aimed to culturally adapt an evidence-based occupational therapy intervention for Hispanic and Latino autistic children and compare two methods of engagement. Hispanic and Latino families often face barriers accessing culturally and linguistically appropriate services and being included in research. This work was needed to ensure interventions are relevant, equitable, and supportive of their needs. The voices of those impacted by this work were included to guide the research process. We engaged 25 people-including parents, autistic adults, occupational therapy practitioners, psychologists, teachers, and cultural experts-to work closely with the research team. They supported the team through advisory boards and helped shape the project in important ways, such as improving how families are invited to join and how information is shared. Meetings were held mostly on Zoom, with some held in person. We measured how often and how meaningfully stakeholders were involved, and both were rated very highly. This shows that strong partnerships are possible and valuable. Listening to community voices can help ensure that research is more relevant, respectful, and effective. Projects such as this can make occupational therapy more accessible for children and families from different cultural and language backgrounds, ultimately improving health equity and quality of care. Positionality Statement: We use the terms Hispanic and Latino throughout this article to support inclusivity. The term Hispanic typically refers to people with Spanish ancestry or Spanish as a primary language; however, it is sometimes viewed as problematic because of its association with Spanish colonization. In contrast, Latino refers to people from Latin America, including the Caribbean. Given the variation in individual and community preferences, we acknowledge the complexity of these identities (Martínez & Gonzalez, 2021). Furthermore, we implement the identity-first terminology for autistic persons on the basis of their preference for using such language (Taboas etal., 2023). The first author, Lady Rios-Vega, identifies as a Latina. She is an occupational therapy practitioner and researcher who has served minoritized families. We acknowledge that her perspectives may influence how data are presented. In addition, the diverse backgrounds and experiences of all contributing authors shape our work, guiding us to pursue our objectives with a strong focus on equity and inclusivity. The senior author, Roseann Schaaf, identifies as a White woman from a middle-class background. She is an occupational therapy practitioner and an experienced autism researcher. She acknowledges the potential impact of her privileged positionality in studying the experiences of marginalized communities, and she is committed to mitigating any biases that may arise from her own perspective.

To examine the relationship between nurse managers' empowering leadership, nurses' resilience and organisational learning from incidents. Cross-sectional observational study. Secondary data from a study conducted in June-July 2022 was used. The sample included 1049 nurses working in three special-functioning hospitals. The self-administered questionnaires assessed nurse managers' empowering behaviours, nurses' resilience and attitudes and behaviours fostering organisational learning from incidents. The analysis employed multilevel analysis with hierarchical linear modelling. Nurse managers' empowering behaviours and nurses' resilience were significantly positively associated with attitudes and behaviours fostering organisational learning from the following incident subscales: make efforts to identify the problem, discuss safety in the workplace, identify and give feedback to address the at-risk behaviour. The interaction of empowering behaviours and resilience was not significant. Nurse managers' empowering behaviours and nurses' resilience can contribute to attitudes and behaviours that foster organisational learning, even when nurses face stressful incidents. Fostering empowering leadership in nurse managers and resilience in nurses enhances organisational learning and improves safety and care quality. The reporting is based on the STROBE guidelines. This study did not include patient or public involvement in its design, conduct or reporting.

Multidisciplinary analysis of teamwork in orthopaedic trauma: How do expectations differ from reality in the operating room environment?

The rise in smartphone use presents opportunities and challenges in clinical settings. Despite guidelines restricting mobile phone use, nurses frequently rely on them for various purposes. While beneficial, smartphone use poses risks to information security, patient safety, and care quality, prompting the need for monitoring. This study examined smartphone usage among nursing students and their perspectives on acceptable and unacceptable use during clinical placements. This cross-sectional study used convenience sampling to recruit undergraduate nursing students from five universities in Australia and New Zealand. Participants completed the Attitude Towards Digital Device Use during Clinical Placement (Adduct) Scale online between September 2021 and August 2022. The survey included closed and open-ended questions. Descriptive and inferential analyses were conducted using SPSS. Exploratory factor analysis identified attitudinal dimensions, while group comparisons assessed demographic variations. Qualitative responses were thematically analysed. Reporting followed the Consensus-Based Checklist for Reporting of Survey Studies (CROSS). Among 279 respondents, drawn from an eligible population of 2682 students, the response rate was 10.4%. Age significantly influenced perceptions of unacceptable smartphone use. Younger students (mean age = 25.0, SD = 9.8) were more likely to view such use as acceptable, with those up to 21 years reporting higher scores on the Unacceptable Use sub-scale compared to older peers (p = 0.024). Most respondents found smartphone use beneficial for accessing information and learning, though concerns included distractions and confidentiality breaches. Younger students were at greater risk of non-adherence to guidelines. Smartphones can enhance learning and efficiency, but clear guidelines and education are needed to balance benefits with risks, particularly for younger students. This study highlights the need for clear guidelines and structured training to balance educational benefits of smartphone use with the risks of distraction and breaches of patient confidentiality in clinical practice. No patient or public pontribution.

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.

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

To identify body temperature dynamic patterns and develop a machine learning model for the early detection of nosocomial infections. A retrospective and observational study of patients hospitalised in the haematology department of the Chinese People's Liberation Army General Hospital between January 2014 and December 2023. A latent class trajectory model was used to discover patterns in patients' body temperatures over time. Machine learning models were then built to predict nosocomial infections and evaluated using standard metrics (AUROC, sensitivity, specificity). SHAP (SHapley Additive exPlanations) values were used to interpret the final model. Among 6989 patients, we identified four distinct body temperature trajectories. Bloodstream infections were most common in patients exhibiting either a slow rise followed by a gradual decrease or a rapid rise followed by a quick decrease in body temperature. The XGBoost model showed excellent predictive performance (AUROC = 0.801), with balanced sensitivity (0.718) and specificity (0.701). The top five predictors of nosocomial infections were elevated procalcitonin, neutropenia, prolonged central venous catheter use and two specific temperature trajectories: 'stable and relatively high' and 'a rapid rise followed by a quick decrease'. The XGBoost model effectively predicted nosocomial infections. Dynamic body temperature trajectories provided early, objective warning signs of infection. This predictive tool empowered nursing staff to proactively monitor nosocomial infection, allowing for timely, data-driven interventions in vulnerable hematologic patients. The developed machine learning predictive tool can help clinical medical staff identify nosocomial infections as early as possible, facilitate personalised rehabilitation and health management plans, aligning with the philosophy of patient-centred precision nursing. Further, the four body temperature trajectory patterns identified provide nurses with objective, dynamic indicators for recognising potential infection subphenotypes, supporting a shift from experience-driven reactive care towards data-driven proactive nursing. Previous studies suggested that body temperature could indicate the severity and prognosis of infections, but the pattern was unknown. In this study, we found that body temperature trajectories could signal infection subphenotypes, such as bloodstream infections being most common in patients with a slow rise followed by a gradual decrease in body temperature or with a rapid rise followed by a quick decrease. By integrating body temperature trajectories with key clinical biomarkers, the developed prediction model enables early and accurate identification of nosocomial infections in hematologic patients. The application of this tool may significantly shorten the time window between infection onset and intervention, potentially reducing infection-related complications, mortality and healthcare costs, thereby improving overall care quality and patient outcomes. The study adhered to the relevant EQUATOR reporting guidelines, the TRIPOD Checklist for Prediction Model Development and Validation. The research team included nursing staff and clinicians responsible for infection surveillance and control in the hospital, who contributed real-world insights into the definition of predictors, interpretation of temperature trajectories, clinical implications of the prediction model and preparation of the manuscript. Their expertise helped ensure that the study addressed relevant clinical questions and that the findings are interpretable and actionable in practice.

Informal caregivers' preferences for self-care support services in caring for community-dwelling older adults with disabilities: A discrete choice experiment.

Associations between job satisfaction, perceived organizational support, and burnout among Jordanian midwives: A cross-sectional study.

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.

Why UK midwives intend to stay in or leave the midwifery profession: A conceptual model of push, pull and mooring factors.

Healthcare practitioners' engagement with non-specialists: A scoping review.

Nurses are central to cancer care for children and adolescents, yet no comprehensive synthesis has defined essential core competencies for pediatric oncology nursing (PON) practice internationally, particularly in Latin America and the Caribbean (LAC). This scoping review mapped and synthesized evidence on PON competencies relevant to clinical practice, education, and research in LAC settings. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-extension for scoping reviews (PRISMA-ScR) and Joanna Briggs Institute (JBI) guidance, we searched Medical Literature Analysis and Retrieval System Online (MEDLINE)/PubMed, Cochrane Library, Excerpta Medica Database (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, Scopus, ScienceDirect, and Latin American and Caribbean Health Sciences Literature (LILACS), and additional sources, including ProQuest Dissertations & Theses Global, British Library, Google Scholar, medRxiv, ClinicalTrials.gov, and the World Health Organization (WHO)-International Clinical Trials Registry Platform (ICTRP), from inception to December 31, 2023, without language restrictions. Two independent reviewers performed study selection, data extraction, and synthesis. A total of 50 studies published between 1987 and 2021 were included. Most were quantitative or expert opinion (n=46), with 21 (42%) addressing clinical practice, 16 (32%) education, and 13 (26%) research. Methodological quality was moderate to high according to JBI appraisal tools. Across studies, 28 core competencies were identified and grouped into six domains: clinical and supportive care (n=16; 57.1%), education and research (n=4; 14.3%), leadership and professional development (n=3; 10.7%), engagement, advocacy and promotion (n=2; 7.1%), interprofessional collaboration across the cancer care journey (n=2; 7.1%), and health policy and service development (n=1; 3.6%). This review synthesizes PON competencies relevant to LAC. Mapping these competencies identifies priorities for workforce development, education, and research and may support efforts to strengthen PON capacity and improve the quality of childhood cancer care across diverse health systems.

Cognitive flexibility, resilience, and anger management are critical for health care workers operating in high-stress environments such as intensive care units (ICUs). This study examined the levels of cognitive flexibility, resilience, and anger management among ICU health care workers and explored the relationships among these variables. This descriptive, cross-sectional, correlational study was conducted between July and October 2022 in the ICUs of a training and research hospital in Türkiye (N = 147). Data were collected via the Cognitive Flexibility Inventory, the Brief Resilience Scale, and the Trait Anger and Anger Expression Scale. Descriptive statistics were calculated, and Pearson correlation analyses were performed. The participants showed high cognitive flexibility (mean ± SD; Cognitive Flexibility Inventory = 78.79 ± 10.13) and moderate resilience (Brief Resilience Scale = 20.76 ± 4.49). Cognitive flexibility was positively correlated with resilience (r = .574, p < .001). Resilience and cognitive flexibility were negatively associated with trait anger and maladaptive anger expression styles (p < .05), whereas resilience was positively associated with anger control (p < .05). Cognitive flexibility and resilience may function as protective factors against maladaptive anger responses among ICU health care workers. Strengthening these competencies may support emotional regulation, reduce burnout risk, and improve the quality of clinical and assistive care in intensive care settings.

Predictors of Prosthetic Eligibility after Major Lower Limb Amputation: A Retrospective Cohort Study.

ObjectiveTo characterize interspecialty variation and areas of consensus in the understanding and clinical management of functional hypothalamic amenorrhea among physicians from different clinical specialties in China.MethodsWe conducted a nationwide, cross-sectional questionnaire survey of licensed physicians practicing in reproductive endocrinology, obstetrics and gynecology, and related specialties involved in functional hypothalamic amenorrhea care. The survey was administered anonymously via a national continuing medical education platform affiliated with the Peking Union Medical College Hospital Alliance between 1 November and 30 November 2025.ResultsA total of 2026 questionnaires were included in the final analysis, comprising 112 reproductive endocrinologists (5.5%), 1516 obstetricians-gynecologists (74.8%), and 398 physicians from other specialties (19.6%). Overall, only 62.7% of respondents recognized genetic susceptibility as a contributing factor to functional hypothalamic amenorrhea, and only 43.9% of respondents perceived that functional hypothalamic amenorrhea was generally diagnosed appropriately. Compared with physicians from other specialties, reproductive endocrinologists and obstetricians-gynecologists were significantly more likely to prioritize sex hormone evaluation, pelvic ultrasonography, and assessment of the thyroid and adrenal axes (all p < 0.01), whereas physicians from other specialties more frequently reported emphasizing assessments of energy metabolism (p < 0.01). Among women without fertility intentions, reproductive endocrinologists were more likely to report prioritizing elimination of precipitating factors (p < 0.05) and recommending hormone replacement and bone-targeted therapies (both p < 0.01). For women desiring pregnancy, reproductive endocrinologists were more likely to report recommending ovulation induction (p < 0.01), whereas physicians from other specialties reported greater support for the use of pulsatile gonadotropin-releasing hormone pumps (p < 0.01).ConclusionsVariations were observed in physicians' self-reported diagnostic and management approaches to functional hypothalamic amenorrhea across clinical specialties in China. These findings suggest the importance of promoting multidisciplinary consensus, developing standardized clinical pathways, and strengthening interdisciplinary collaboration to improve the quality of care for women with functional hypothalamic amenorrhea.