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Background: With the increasingly demanding healthcare environment, patient safety issues are only becoming more complex. This urges nursing leaders to adapt and master effective leadership; particularly, transformational leadership (TFL) is shown to scientifically be the most successfully recognized leadership style in healthcare, focusing on relationship building while putting followers in power and emphasizing values and vision. Aim: To examine how transformational leadership affects nurses’ job environment and nursing care provided to the patients and patients’ outcomes. Design: A systematic literature review was conducted. From 71 reviewed, 23 studies were included (studies included questionnaire surveys and one interview, extracting barriers and facilitators, and analyzing using qualitative synthesis). Result: TFL indirectly and directly positively affects nurses’ work environment through mediators, including structural empowerment, organizational commitment, and job satisfaction. Nurses perceived that managers’ TFL behavior did not attain excellence in any of the included organizations, highlighting the necessity for additional leadership training to enhance the patient safety culture related to the non-reporting of errors and to mitigate the blame culture within the nursing environment. Conclusion: Bringing more focus to leadership education in nursing can make future nursing leaders more effective, which will cultivate efficient teamwork, a quality nursing work environment, and, ultimately, safe and efficient patient outcomes. This study was not registered.

This entry discusses the importance of cultural competence in the healthcare of humans and animals, its challenges, its mixed research results, and the need for widely applicable competencies. Although there is research evidence showing that cultural competence is linked with patient satisfaction, better doctor–patient relationships, adherence to therapy, and to some extent, better health outcomes, there is a huge variety of models and competencies in the literature, which has sometimes resulted in inclusive outcomes, confusion as to what constitutes the necessary competencies, and patchy implementation. In spite of the development of cultural competence in human healthcare, its implementation in veterinary medicine remains poor. On this note, the aims of this entry are to provide a brief overview of the cultural competence in healthcare and veterinary medicine and education, to outline the important facts, and to highlight the need for more standardisation in implementing and testing widely applicable cultural competencies for both human and veterinary healthcare.

Background: In the existing literature, there are many guidelines regarding cultural competencies for healthcare professionals and many instruments aiming to measure cultural competence. However, there is no consensus on which core cultural competencies are necessary for healthcare professionals. Aim and Methods: This study employed the PRISMA 2020 statement to systematically review Delphi studies and identify the core cultural competencies on which experts, who have been working with diverse populations in the fields of healthcare and allied healthcare, have reached a consensus. For this purpose, we searched, retrieved, and reviewed all Delphi studies conducted between 2000 and 2022 in the databases Scopus, PubMed, CINAHL, Medline, and PsycInfo and coded and synthesised the results qualitatively. Results: The systematic search resulted in 15 Delphi studies that met eligibility criteria and in which 443 experts from 37 different countries around the globe had participated. The review of these Delphi studies showed that the core competencies necessary for healthcare professionals to ensure that they provide culturally congruent care were: Reflect, Educate, Show Interest and Praise, Empathise, and Collaborate for Therapy. Discussion and Conclusion: These competencies make the abbreviation and word RESPECT, which symbolically places emphasis on respect as the overarching behaviour for working effectively with diversity. The study also provides a new, comprehensive definition of the cultural competence of healthcare professionals and opens new directions in formulating standardised guidelines and research in cultural competence in healthcare and allied healthcare.

Cultural competence in healthcare has been defined in many ways; however, it generally refers to knowledge of social and cultural factors that influence illness and related behaviour, and actions taken to provide the best of quality care considering each patient’s background [...]

The elderly population globally is estimated to grow by one-third of the world’s population by the year 2050. At the same time, elder abuse and neglect have been acknowledged as major growing concerns. With the growing elderly population and increasing concerns about elder abuse, understanding the ways to deal with elder abuse is important. The healthcare professionals, especially nurses, are among the first groups who come in contact with the elderly population and can identify and assess cases of elder abuse. There is evidence to suggest that nurses lack knowledge in the assessment, identification, management, and reporting of an elder abuse case. This study aims to explore the available literature in the effectiveness of training programs for nurses in elder abuse management. The search strategy included the electronic databases CINHAL, Medline, and Health Source. A total of 646 research articles published between 2010 and 2021 were screened against inclusion and exclusion criteria. After reviewing and removing duplicates and irrelevant studies, 14 articles were included in this review. The findings of this literature review revealed that providing education and training for nurses in elder abuse can enhance their knowledge and increase identification and reporting of elder abuse cases. It also indicated that mixed teaching methods, such as face-to-face lectures, simulation, or case scenarios and debriefings or feedback can strengthen the learning process of nurses. In conclusion, educational programs for nurses can significantly improve the identification, reporting, and handling skills of elder abuse incidents. This finding can help in developing accurate strategies for minimizing and preventing elder abuse cases. From the results of this systematic review, we propose the ECLiPSE pathway for the effective training of nurses and handling of elder abuse cases, eventually contributing to decreasing the incidents.

Aim: The aim of the study was to understand how non-specialized nurses and people with diabetes understand nurses’ roles in diabetes inpatient care. Background: Diabetes mellitus is a major public health issue that places a significant burden on patients and healthcare systems and world leaders have targeted it for priority action. Design: An interpretative phenomenology approach (IPA). Methods: A total of 24 non-specialized nurses working in medical, surgical and nephrology wards and 24 people with type 1 diabetes who use the services of the state hospitals in Cyprus. The data were collected in two phases: firstly, focus groups with nurses (n = 1) and people with diabetes (n = 2) were conducted and analysed and then individual semi-structured interviews with nurses (n = 18) and with people with diabetes (n = 12) were conducted. Findings: It is evident from the study findings that nurses experience several roles in diabetes inpatient care. Most of these roles have been identified by people with diabetes as well. These roles are summarized as follows: medication administration, patient education, screening of complications, diet and psychological support. However, most of the participants raised concerns about nurses’ ability to conduct such roles. Conclusion: Participants suggest that nurses experience several roles in caring for diabetes inpatients and this view was also shared by people with diabetes. However, it was obvious that these roles differ between specialities. The findings showed that even though participants recognized a number of roles in diabetes inpatient care, their description of how they perform these roles was vague, and they raised concerns about their readiness to take on some of these roles.

Mental illness among medical students in particular, and higher education students in general, is very high. Many measures have been suggested in order to improve the situation, including training members of faculty and staff. However, to the best of our knowledge there seem to be no studies proposing training programmes for medical schools’ faculty and staff in response to recognising students’ psychological difficulties and symptoms in order to provide the relevant support. Also, in cases where such training for supporting medical students with psychological symptomatology exist, the efficacy of the approach employed is not known. By employing a careful literature search according to published guidelines for narrative literature reviews, this study aimed to fill in this identified gap in the literature. From the literature search, 14 articles were included in this review and the results show that no training tailored for faculty and staff in medical schools was identified. However, articles that related to higher education were included because they were useful in providing insights for medicine, and show the following: (a) faculty and staff acknowledged the importance of mental illness among students, (b) many of them discussed with their students psychological symptoms and provided support, (c) they tended to feel unprepared for recognising students’ psychological symptoms successfully and providing support, (d) they embraced the idea of being trained, and (e) any training seemed to be helpful for members of faculty and staff. From the results of this narrative review, we propose the CReATE circular pathway to ensure a sustainable process of training and support for students’ development.

This paper presents the results of a narrative literature review on the use of interpreters in medical education. A careful search strategy was based on keywords and inclusion and exclusion criteria, and used the databases PubMed, Medline Ovid, Google Scholar, Scopus, CINAHL, and EBSCO. The search strategy resulted in 20 articles, which reflected the research aim and were reviewed on the basis of an interpretive approach. They were then critically appraised in accordance with the “critical assessment skills programme” guidelines. Results showed that the use of interpreters in medical education as part of the curriculum is scarce, but students have been trained in how to work with interpreters when interviewing patients to fully develop their skills. The study highlights the importance of integrating the use of interpreters in medical curricula, proposes a framework for achieving this, and suggests pertinent research questions for enriching cultural competence.

Student-centered learning (SCL) has been acknowledged and supported by research as very important for helping students develop life-long independent learning and transferable skills. Yet the implementation of SCL in European higher education has been patchy where experts in the field call for the need for a framework that could guide higher education institutions (HEIs) in designing and implementing SCL. This paper aims to fill in this identified gap by reflecting on the basic literature and social theory to propose the reflexive GOAL (Goals (vision and objectives), Organization (structures), Actions (immersion into structures and actions), and Learning a culture (instilled through reflexivity)) framework for the implementation of SCL in higher education in its broader sense to encompass elements from in-class learning to extra-curricular and community engagement.

Background: The aim of this study was to comprehend how people with diabetes view their experiences of the possible barriers and facilitators in inpatient care for type 1 diabetes from non-specialized nurses. Design: An interpretative phenomenology analysis (IPA) was conducted. Methods: The sample consisted of people with type 1 diabetes 1 (n = 24) who use the services of the state hospitals in Cyprus. The data were collected in two phases: firstly, focus groups with people with diabetes (n = 2) were conducted and analysed, and then individual semi-structured interviews with people with diabetes (n = 12) were conducted. Results: It is evident from the findings that people with diabetes experienced several barriers in diabetes inpatient care, which is concerning since this can have adverse effects on patients’ outcomes. No facilitators were reported. Conclusion: Significant results were found in relation to the barriers to diabetes inpatient care. Crucially, the findings demonstrate that all these factors can negatively affect the quality of care of patients with diabetes, and most of these factors are related not only to diabetes care but also generally to all patients who receive inpatient care. Interestingly, no participant reported any facilitators to their care, which further affected the negative perceptions of the care received.

Problem-Based Learning (PBL) is well known for enhancing students’ problem-solving skills and teamwork, while the role of PBL tutors is to facilitate discussion rather than teach. This study used four focus groups to explore PBL tutors’ motivation, challenges and support mechanisms, and the relationship between these. The study found that there was a narrative alignment, whereby tutors identified a challenge if it disrupted their motivation to tutor, and support as effective if it addressed the challenge so as to re-establish their motivation. Based on this, we propose the “Motivation, Challenges, Support (MCS) Cycle Model” for the development of PBL tutors.

Background: Research findings suggest that attitudes towards psychotherapy predict willingness to seek therapy. However, understanding how medical students think about using and referring their patients for psychotherapy is limited. Aims: The aims of this study are to measure medical students’ attitudes towards professional help seeking, and to investigate the reasons for whether or not they would refer their patients to psychotherapy in their future role as doctors. Method: The participants were 127 medical students in their first and second year of the MBBS4 programme at the Cyprus campus of St George’s University of London, who completed a self-report measure of attitudes towards psychotherapy and a semi-structured interview. Findings: Participants showed general positive attitudes towards psychotherapy, but were reluctant to use or refer their patients, largely due to perceived stigma and accessibility. Conclusions: Medical students should be further trained in order to become more confident in using psychotherapy and referring their patients.

Abstract Aim The aim and objective of this study was to understand how non‐specialized nurses understand the possible barriers and facilitators of inpatient care for type 1 diabetes. Design An interpretative phenomenology approach was conducted. Methods The sample consisted of non‐specialized nurses (N = 24) working in medical, surgical and nephrology wards in the state hospitals in Cyprus. The data were collected during 2016‐2018 from one focus group with nurses (N = 6) and individual semi‐structured interviews with nurses (N = 18) conducted. The Standards for Reporting Qualitative Research checklist used to ensure the quality of the study. Results It is evident from the study findings that nurses experience several barriers in diabetes inpatient care reported which are of great concern since this could have adverse effects on patients' outcomes. Only one facilitator has been reported by few nurses.

Critical reflection on own beliefs, within the context of cultural competence, has been acknowledged as an important skill doctors and medical students should have in order to enhance the quality of health care regardless of patients’ social and cultural background. Yet the guidelines for teaching students critical reflection on their own cultural beliefs are lacking. Based on the method of investigating short reflective narratives and Gibbs’ reflective cycle for development, this paper explores the experience of clinical communication tutors’ in examining cultural competence in OSCEs, how they felt, analyzed and concluded, and examines their account on how to construct a training model for dealing with such challenge in medical education.

Background: The aim of this review is to identify the roles and activities of nurses working with people with diabetes and to examine the facilitators and barriers in caring for such people. Methods: A systematic review was conducted. From 531 abstracts reviewed, 29 studies were included (18 studies comprised questionnaire surveys, one was an intervention study, two used both questionnaires and interviews, and eight of them used interviews). Barriers and facilitators were extracted and combined using qualitative synthesis. Results: The literature review revealed three major roles and a number of barriers. A model for achieving enhanced nursing care of patients with diabetes has been developed according to the findings of this literature. Specifically, a stepladder suggesting that through better nursing training and education and by providing adequate resources, time, and synergies to diabetes specialists, nurses will be able to correctly perform their diabetes care roles, which include patient education, advanced care, and psychological support. Conclusions: Taking into serious consideration that a large number of hospital users are people with diabetes and that there is an inconsistency among countries about the work settings of Diabetes Specialist Nurses (DSNs), it is important to give greater focus to inpatient care and perhaps to enhance nurses’ roles by eliminating any barriers that prevent them from providing adequate quality care. Furthermore, integrated care involving the role of DSNs within the inpatient care would have been more beneficial for patients.