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Background: Burns can cause patients significant pain at the time of injury and during subsequent treatment. Other people's pain often elicits empathic responses in observers. However, effective emotion regulation strategies are needed to manage personal distress, which may otherwise inhibit helping behaviour., Methods: This study used an interpretative qualitative approach to conduct semi-structured interviews with burns nurses. Interviews explored emotion regulation strategies used by nurses whilst causing pain to adult patients during burns dressing changes. Transcripts were analysed using Braun and Clarke's six stages of thematic analysis., Results: Eight burns nurses participated in the interviews. Thematic analysis developed five themes: Emotions get in the way of being a good nurse; Pain's an inevitable and justifiable part of treatment and healing; If I'm not made aware of the pain, maybe there is no pain; The pain's due to other factors, not my actions; and Sometimes it's too much., Conclusion: Burns nurses' attempts at regulating their emotions were influenced by their beliefs about what makes a 'good' nurse. Gross's model of emotion regulation provides a useful framework for understanding these strategies, but further research is needed into the helpfulness thereof for nurses and patients., Competing Interests: Declaration of Competing Interest All authors declare that they have no conflicts of interest. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors., (Copyright © 2024 International Society of Burns Injuries. All rights reserved.)

Aim: Pelvic binder application is one of the life-saving interventions used in pelvic trauma. The aim of this study was to evaluate the effect of a pelvic binder training program on the knowledge, skills, attitudes and competence levels of emergency department nurses., Methods: The study was conducted with 35 emergency department nurses using a one-group pretest-posttest design. The effectiveness of the training provided to the nurses was evaluated in four stages: immediately before the training, immediately after the training, 20 days after the training, and two months after the training, using forms developed by the researchers. The evaluation assessed knowledge, skills, attitudes, and perceived levels of competence related to the topic., Results: Attitudes toward pelvic binder application and perceived competence levels in providing care for patients with pelvic binders were significantly higher in all post-training assessments compared to pre-training (p < 0.001). Knowledge levels were significantly higher two months after training compared to other time periods (p < 0.001). It was also found that pelvic binder application training for ED nurses significantly improved nurses' skills (p < 0.001)., Conclusion: In conclusion, this study shows that the pelvic binder training program is effective in improving the knowledge, skills, attitudes, and competence levels of emergency department nurses. To improve patient care in critical situations such as pelvic trauma, the dissemination and continuity of such training programs will be an important step., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Türkiye encounters various natural disasters, foremost earthquakes, and, nurses' resilience, ability to cope with stress and disaster competence play a significant role in disasters., Objective: The objective of this study is to establish the intermediary role of resilience in the relation between nurses' competencies in disaster management and perceived stress., Method: The sampling of this descriptive and cross-sectional study included 240 nurses from across Türkiye. The socio-demographic characteristics questionnaire, Competencies for Disaster Nursing Management Questionnaire, Brief Resilience Scale, Perceived Stress Scale were utilized in order to collect data. Among the continuous variables of the research, Pearson correlation analysis, linear regression and hierarchical regression analyses regarding the intermediary effect were performed by using PROCESS Model., Findings: The mean scale scores of nurses were detected to be "CDNMQ" 6.300 ± 2.771 (medium), "BRS" 18.463 ± 4.308 (medium), and "PS" 21.038 ± 6.759 (low), respectively. The relationship between CDNMQ and PS (path c; ß = -0.534) descends in case BRS is added to the model (path c'; ß = -0.429) (p < 0.05). In light of this finding, BRS was determined to be a partial intervening variable between CDNMQ and PS., Conclusion: In accordance with this study, it is recommended to plan studies to enhance disaster nursing competence, prioritize resilience, and reproduce this study in various nurse groups., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Purpose: Work engagement among emergency nurses is a critical issue that adversely affects the quality of patient care and productivity. Psychological reactions (e.g., stress, anxiety, and depression) and resilience correlated with work engagement. This study addresses the gap in understanding the factors correlating work engagement among. emergency nurses in the West Bank during the Gaza War., Methods: A descriptive correlational design was used. The data were collected from 378 emergency nurses from governmental and private hospitals in the West Bank using a self-reported questionnaire from December 2023 to February 2024. Depression Anxiety Stress Scales-21 (DASS-21), the Connor-Davidson Resilience Scale (CD-RISC), and the Utrecht Work Engagement Scale (UWES) were used to assess the study variables., Results: The findings demonstrated that 71.7 %, 52.9 %, 42.5 %, 55.6 %, and 40.0 % of the emergency nurses reported severe to extremely severe stress, moderate to extremely severe levels of anxiety, severe to extremely severe levels of depression, low resilience, and low to extremely low levels of job engagement, respectively. A positive relationship existed between work engagement and age (r = 0.407, p < 0.01), years of experience (r = 0.385, p < 0.01), and resilience (r = 0.419, p < 0.01). While, work engagement negatively correlated with stress (r = -0.486, p < 0.01), anxiety (r = -0.616, p < 0.01), and depression (r = -0.632, p < 0.01)., Conclusions: The findings indicated that policymakers and healthcare professionals should promote initiatives that enhance nurses' resilience and mitigate psychological responses to improve work engagement. Therapeutic programs should consider the situational variations of Palestinian society, encompassing resilience, coping mechanisms, and psychological management approaches., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objectives: This study aimed to determine practice and confidence in electrocardiogram (ECG) interpretation among intensive care unit (ICU) nurses in Fujian Province, China, and identify predictors of ECG interpretation practice., Research Methodology/design: A quantitative cross-sectional study was conducted between October 2021 and December 2021 among 357 respondents., Setting: Conducted online at twenty-one hospitals in all nine cities of Fujian Province., Main Outcome Measures: Purposive and convenient sampling techniques were employed in selecting hospitals and respondents, respectively. A validated and pre-tested Chinese version of the questionnaire was used in data collection. We conducted binary logistic regression to identify the predictors of ICU nurses' ECG interpretation practice, and linear regression to analyze the relationship between ECG interpretation practice and confidence. We considered statistically significant a p-value < 0.05., Results: The practice mean score of the respondents was 5.54 (SD = 2.26) out of 10 points, and only 2.2 % of nurses correctly interpreted all the patient ECG strips. Few ICU nurses (25.5 %) had good ECG interpretation practice, with a confidence mean score of 2.02 (SD = 0.99) out of 4 points in their overall ability to interpret patient ECG strips. Currently working unit in comparison to cardiac ICU (emergency ICU: AOR = 5.71, 95 % CI: 1.84-17.75); previous ECG training (AOR = 2.02, 95 % CI: 1.10-3.70); source of ECG training (university/school) (AOR = 2.02, 95 % CI: 1.12-3.65); and ECG knowledge (AOR = 16.18, 95 % CI: 7.43-35.25) were significantly associated with the ECG interpretation practice., Conclusions: ICU nurses' ECG interpretation practice in the current study was relatively poor. An ECG education program is recommended to impart ICU nurses with basic ECG knowledge for enhancing good ECG interpretation practice and confidence in nursing care provision., Implications for Clinical Practice: Good ECG interpretation skills are paramount among ICU nurses for better patient outcomes. ECG knowledge among ICU nurses is an important predictor of effective ECG monitoring for cardiac arrhythmias. Therefore, frequent, continuouszgood practice and boost confidence in the provision of quality nursing care., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Introduction: In ambulance services, personnel often work together in teams. There are two personnel in ambulances, at least one of whom is a registered nurse. Besides leading nursing work, the registered nurse should be able to lead and work in teams. The registered nurse develops an intuitive approach through work experience, enabling them to act without analysing their actions., Aim: This study illuminates registered nurses' perceptions of factors affecting teamwork and solo work in ambulance care., Method: The sample consisted of ten registered nurses from ambulance stations in western Sweden. Semi-structured individual interviews were analysed using qualitative content analysis, according to Graneheim and Lundman (2004)., Results: Ambulance healthcare nurses emphasise continuous teamwork, where clear roles and effective communication are key. Team continuity fosters trust among colleagues for a safer work environment. Striking a balance between new and experienced staff is crucial. Experience and reflection are vital for building professional knowledge, instilling confidence, and fostering an intuitive approach., Conclusion: Secure teamwork and solo work require experience, continuity, distinct roles, communication, and reflection., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Introduction: This study was aimed at understanding emergency department (ED) nurses' experiences of caring for people who attempted suicide. ED nurses provide care to a great number of patients who have attempted suicide. EDs are accepted as an important environment to prevent repeat suicidal behavior and the importance of initiating interventions to prevent repeated attempts is emphasized., Method: This study was a descriptive qualitative study. The study was conducted with 15 ED nurses who provided care to individuals who attempted suicide in two university hospitals in Turkey. Data were collected through face-to-face, semi-structured in-depth interviews. The data were analyzed using content analysis. Consolidated criteria for reporting qualitative studies (COREQ) were used to ensure the comprehensive reporting of this qualitative study protocol., Results: The data were categorized under the following four themes: elements of current care, barriers to effective care, dimensions that should be improved in providing care, and needs., Conclusion: Biomedical approaches constitute the basic elements of nurses' care provided to a suicidal patient, and nurses have difficulty in providing emotional support. Caring for a suicidal patient creates an emotional burden for nurses. Nurses stated that they were faced with barriers related to emotional burden, stigma, lack of time, knowledge gaps, and unsuitable physical environment., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: In 2016, a selective preventive spinal immobilization protocol for emergency medical service (EMS) nurses was introduced in the Netherlands. This protocol leaves more room for autonomous decision-making in the pre-hospital phase regarding preventive spinal immobilization (PSI), compared to the previous strict protocol. In this study, we explored the experiences and perspectives of EMS nurses on decisionmaking about PSI after the change from a strict to a selective PSI protocol., Methods: We used a qualitative design with semi-structured face-to-face interviews. Thematic analysis was applied. The capability-opportunity-motivation-behavior-model was used to interpret the experiences and perspectives., Results: Thirteen EMS nurses from three emergency medical services were interviewed. Respondents appreciated autonomous decision-making as there was more room for patient-centered informed decision-making. However, autonomous decision-making required optimized knowledge and skills and elicited the need to receive feedback on their decision not to apply PSI. When nurses anticipated resistance to selective PSI from receiving hospitals, they were doubtful to apply it., Conclusion: Nurses appreciate the increased autonomy in decision-making, encouraging them to focus on patient-centered care. Increased autonomy also places higher demands on knowledge and skills, calling for training and feedback. Anticipated resistance to receiving hospitals based on mutual protocol discrepancies could lead to PSI application by EMS nurses while not deemed necessary., Recommendations: To enhance PSI procedures, optimizing the knowledge and skills of EMS nurses that facilitate on-scene decision-making may be indicated. A learning loop for feedback between the EMS nurses and the involved hospitals may add to their professional performance. More efforts are needed to create support for the changed Emergency Medical Services strategy in PSI to prevent unnecessary PSI and practice variation., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Examining factors affecting nursing care is vital for enhancing practices, improving care quality, and achieving desired patient outcomes., Aim: To explore emergency nurses' perceptions of care quality, compassion fatigue and conscience stress levels; and evaluate the mediating role of conscience stress between compassion fatigue and perception of nursing care quality., Methods: This cross-sectional and descriptive study was conducted between April 1 and September 1, 2022, with 384 nurses working in emergency departments across Turkey. "Sociodemographic Data Collection Form", "Compassion Fatigue Scale", "Stress of Conscience Scale" and "Caring Behaviors Scale" were used to collect data., Results: The mean total scores for the Caring Behaviors Scale, Compassion Fatigue Scale, and Conscience Stress Scale among emergency nurses were 5.16 ± 0.67, 71.28 ± 25.19, and 100.48 ± 41.97, respectively. The study revealed a positive correlation between Conscience Stress Scale and Compassion Fatigue Scale scores, and no correlation between Caring Behaviors Scale scores. Additionally, a negative correlation was found between Compassion Fatigue Scale and Caring Behaviors Scale scores., Conclusion: It was found that emergency nurses had high perceptions of care quality, moderate levels of compassion fatigue and stress of conscience, and that stress of conscience did not mediate the relationship between perception of care quality and compassion fatigue., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objectives: To explore communication experiences, resource accessibility/quality, and communication strategies cardiac nurses use when caring for Chinese-speaking patients., Methods: In this exploratory qualitative study, nurses were recruited from professional association members and interviewed on communication barriers/facilitators, resource accessibility/quality, and communication strategies used when caring for Chinese-speaking cardiac patients. Transcripts were thematically analysed., Results: Nurses (n = 11) were primarily female (7/11), with 2/11 Chinese-speaking. The themes discussed centred on two areas that created difficulty in communication, including the lack of a common language and uncertainty of the Chinese culture. Dependence on interpreters was highlighted and challenges noted included limited availability and difficulty scheduling, variable quality and approaches, and lack of communication resources leading to a dependence on poor quality materials. Nurses were uncertain about Chinese culture and how to communicate, particularly in relation to family-centred beliefs, mental and sexual health, medication, and diet., Conclusions: Health communication with Chinese-speaking patients needs to address multiple challenges to be effective., Practice Implications: The findings emphasise the need to optimise interpreting services and provide nurses with cultural competency training and tailored resources to improve their understanding of Chinese immigrants' needs. These recommendations will support nurses to address identified language and cultural uncertainties., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Objectives: This study explored the bidirectional relationship between job burnout and empathy among Chinese nurses., Methods: A nurse cohort was assessed longitudinally in 2020 (T1) and 2022 (T2). Participants completed the Maslach Burnout Inventory (MBI)-Human Services Survey and the Jefferson Scale of Empathy-Health Professionals., Results: Out of the 1090 nurses who participated in both assessments, 551 (50.6 %) exhibited job burnout. Nurses with no burnout, discontinued burnout, and newly developed burnout groups had higher levels of empathy than the persistent burnout group. There is a bidirectional negative association between empathy and job burnout, particularly in the depersonalization and low personal accomplishment. Notably, empathy did not predict the emotional exhaustion from burnout, but heightened emotional exhaustion predicted diminished empathy., Conclusion: The findings suggest a significant bidirectional negative association between empathy and job burnout, especially in depersonalization and low personal accomplishment. Notably, nurses without burnout, discontinued burnout, and newly developed burnout exhibited higher levels of empathy, emphasizing the potential impact of addressing and mitigating burnout on fostering empathetic behavior., Practice Implications: Interventions targeting both burnout and empathy are vital for nurses. Recognizing and addressing burnout can positively impact fostering empathetic behavior in nursing practice., Competing Interests: Declaration of Competing Interest The authors declare that no any financial and personal relationships with other people or organizations that could inappropriately influence (bias) their work., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Problem: It is unknown whether the deployment of registered nurses to assist midwives in the provision of postnatal care eases the burden of workforce shortages., Background: The largest public maternity health service in Western Australia began employing registered nurses in 2022 to assist midwives with the provision of postnatal care on maternity wards in response to staffing shortages, exacerbated by COVID-19., Aim: To explore midwives' and registered nurses' experiences of providing postnatal care on maternity wards together., Methods: A descriptive cross-sectional design was employed. Quantitative and qualitative data were collected using a paper-based survey tool. Data were analysed using descriptive and inferential statistics. Content analysis was conducted on qualitative data., Results: 70 staff participated (n= 58 midwives, n=12 nurses). Only 19.2 % of participants felt positively about their workload allocation. Most participants (62.7 %) reported a usual allocation of 6-7 mother-baby dyads to care for. Significantly more midwives preferred allocation by the shift coordinator than nurses; and significantly more nurses preferred 'team nursing' than midwives., Discussion: Strategic approaches are needed to improve recruitment and retention of midwifery workforce capable of responding to periods of acute demands across the full scope of midwifery practice. Guidance concerning nurses' scope of practice in the postnatal setting is necessary from a professional, medico-legal, governance and safety standpoint., Conclusion: The deployment of registered nurses into postnatal wards may be of some benefit to midwives in the context of workforce shortages. Parameters must be set outlining what is within nurses' scope of practice in the postnatal care setting., Competing Interests: Declaration of Competing Interest No conflict of interest was declared by the authors., (Copyright © 2024 Australian College of Midwives. All rights reserved.)

Objective: This paper aims to explore nurses' experiences with ad-hoc patient education (AHPE) in an acute inpatient setting., Methods: We conducted nine focus groups with 34 nurses. Data was analysed using thematic analysis and the social-ecological model (SEM)., Findings: We identified two main themes. 1) characteristics of AHPE: the complexity, contents, and timing of AHPE, as well as features of successful AHPE. The central phenomenon was the subconscious and incidental nature of AHPE. This negatively impacts charting and recognition of patient education as a core nursing responsibility. 2) requirements for successful AHPE, using the SEM: a) interpersonal level: nurses' own expertise, personality traits, and attitude; b) intrapersonal level: relationship building, communication at eye-level, and recognising patients' receptivity and education needs; c) institutional level: environmental factors (time, space, and clear responsibilities within care teams) and the charting system; d) social level: recognition and appreciation for the value of patient education., Conclusion: AHPE often occurs subconciously and unreflected. Patient education can positively impact patient outcomes; however, this requires a complex interaction of factors on multiple systemic levels., Practice Implications: Awareness raising for AHPE, its value for patients and society, and its proper charting is needed on multiple levels to ensure patient safety and the peace of mind of care teams., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: ASP, AST, and MJP have a background in nursing and are employed by the provider of the hospitals in which the data was collected. However, apart from requesting that individual participants’ quotes should not be attributable to any specific one of the three research sites, the hospital provider did not interfere with the conception, execution, analysis, or presentation of this research., (Copyright © 2024. Published by Elsevier B.V.)

Objective: To evaluate the effects of a 4-week Delirium Introduction and Maintenance programme based on the knowledge-to-action framework on nurses' knowledge, self-confidence, attitudes, and screening accuracy for delirium in the paediatric intensive care unit (PICU)., Research Methodology/design: A quasi-experimental study with a pretest-posttest design., Setting: This study was conducted between January and February 2024 with nurses in two Indonesian PICUs., Main Outcome Measures: Nursing knowledge, self-confidence and attitudes were measured at baseline and the third and fourth weeks (maintenance period) after the intervention was implemented. The Cornell Assessment of Pediatric Delirium (CAPD) was used to evaluate the screening accuracy for delirium at the third and fourth weeks postintervention., Results: A total of 44 nurses with a mean age of 28 years participated in the intervention. At weeks 3 and 4 after the intervention, the intervention group exhibited substantial improvements in knowledge (B = 1.35 and 1.39), self-confidence and attitudes (B = 1.26 and 1.29), and screening accuracy (B = 0.25 and 0.27) compared with the control group (all P < 0.05). The nurses' screening accuracy for delirium by using the CAPD improved from 50 % (week 1) to 86 % (week 3) and 100 % (week 4) in the intervention group, whereas the nurses' screening accuracy for delirium in the control group modestly increased from 17 % to 33 % (week 3) and 37 % (week 4)., Conclusions: The theory-driven, multimodal intervention improved the nurses' knowledge of delirium, self-confidence and attitudes, and screening accuracy for delirium. Implementing comprehensive delirium education programmes can enhance delirium recognition and management in PICUs. Future studies should investigate the long-term effects of delirium education programmes on patient outcomes., Implications for Clinical Practice: An integrated instructional approach was employed to improve nurses' knowledge, self-confidence, attitudes, and screening accuracy for delirium., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Introduction and Objective: The global shortage of nurses who want to work in the intensive care unit (ICU) is alarming, putting at risk quality of care and patient safety. With efforts put into engagement strategies, optimized recruitment programmes are scarce, specifically in the ICU setting. The aim of this study is to describe and explore ICU nurses' opinions on their work motivational factors that influenced the decision to work in the ICU setting., Design: A qualitative research was undertaken, with a descriptive exploratory interpretative approach, implementing a QUAL-QUAL design, where two data collection techniques are used simultaneously and complement each other. Experienced ICU nurses were interviewed by focus group, using in-depth interviews for novel nurses. A template content analysis as described by the model of Brooks was performed., Setting: The selected population was recruited from 6 different public hospitals in Spain., Findings: A total of 17 nurses participated in the study as we reached data saturation; seven in the focus group and ten by individual interviews. Four main themes emerged from the analysis divided into 13 subthemes: "ICU training and education", "taking care of the intensive carer", "optimized human resources management" and "intrinsic and extrinsic motivational factors"., Conclusion: Nurses consider that an attractive ICU in terms of job satisfaction is the one that is committed to quality continuous training programmes, welcoming professionals with well-designed mentoring, and taking care of its workers by promoting teamwork and work-life balance, burnout syndrome prevention strategies and motivation for intellectual development., Implications for Clinical Practice: The description of how to create attractive ICUs will help to build strategies with the aim of recruiting talented highly qualified professionals who will alleviate the need for nurses in the field, optimizing the care provided and generating benefits in management and quality of care., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objectives: To evaluate the impact of Artificial Intelligence Assisted Prevention and Management for Delirium (AI-AntiDelirium) on improving adherence to delirium guidelines among nurses in the intensive care unit (ICU)., Research Methodology/design: Between November 2022 and June 2023, A cluster randomized controlled trial was undertaken., Setting: A total of 38 nurses were enrolled in the interventional arm, whereas 42 nurses were recruited for the control arm in six ICUs across two hospitals in Beijing, comparing nurses' adherence and cognitive load in units that use AI-AntiDelirium or the control group., Main Outcome Measures: The AI-AntiDelirium tailored delirium preventive or treated interventions to address patients' specific risk factors. The adherence rate of delirium interventions was the primary endpoint. The other endpoints were adherence to risk factors assessment, ICU delirium assessment, and nurses' cognitive load. The repeated measures analysis of variance was utilized to explore the influence of time, group, and time × group interaction on the repeated measurement variable (e.g., adherence, cognitive load)., Results: A cumulative total of 1040 nurse days were analyzed for this study. The adherence to delirium intervention of nurses in AI-AntiDelirium groups was higher than control units (75 % vs. 58 %, P < 0.01). When compared to control groups, AI-AntiDelirium was found to be significantly effective in both decreasing extraneous cognitive load (P < 0.01) and improving germane cognitive load (P < 0.01)., Conclusions: This study supports the effectiveness of AI-AntiDelirium in enhancing nurses' adherence to evidence-based, individualized delirium intervention and also reducing extraneous cognitive load., Implications for Clinical Practice: A nurse-led systemshould be applied by nursing administrators to improve compliance with nursing interventions among ICU nurses., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Critical care nurses provide bedside care around the clock, which offers a unique opportunity to integrate rehabilitative activities into routine care. How nurses perform such activities is underinvestigated., Aim: To explore how competencies related to early rehabilitation emerged in the clinical practice of critical care nurses, and to explore their reflections on this aspect of their clinical practice., Study Design and Methods: A qualitative study with a phenomenological-hermeneutic approach was conducted in two Norwegian ICUs from January 2022 to January 2023. Observations and video recordings of eight nurse-patient dyads were conducted, followed by post-observation nurse interviews. Data were analysed using Heath and Luff's video analysis and Malterud's systematic text condensation, with additional insights drawn from Benner's work on clinical knowledge., Findings: Three categories emerged: 1) range in clinical assessments, displaying adequate assessments and actions related to major organ systems but lacking attention towards the assessment and facilitation of movement; 2) nurses' and physiotherapists' cooperation in terms of roles and responsibilities, revealing established roles within their professions and sparse sharing of situated considerations; and 3) grounding the patient, how the nurses used a verbal and attentive approach that appeared to ground their patients in the present, potentially enhancing participation., Conclusions: Nurses were familiar with essential assessments and interventions connected to major organ systems, both independently and with physiotherapists, as well as in verbal communication. However, they were less familiar with assessing and facilitating movements, sharing professional knowledge, and using bodily communication skills., Implications: This study highlights competencies that can be further explored and developed in CCNs clinical practice and education to improve care for critically ill patients. Future research should further investigate CCNs' roles in early rehabilitation and identify independent nursing interventions, especially where resources and multidisciplinary support are limited., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Ensuring a good death in the intensive care unit (ICU) is crucial due to high global mortality rates. Despite the central role of nurses in end-of-life care, existing reviews often focus on patients or families and overlook nurses' perspectives., Objectives: This study aims to investigate the factors associated with a good death for end-of-life patients in the ICU based on nurses' perspectives by systematically summarizing current evidence., Methods: The researchers utilized a systematic review followed the PRISMA 2020 guidelines and was registered with PROSPERO. Databases searched included Scopus, ProQuest, PubMed, ScienceDirect, EBSCOhost, and Google Scholar. Inclusion criteria covered English-language quantitative studies published from the inception until February 20, 2024, that reported factors influencing a good death from the perspective of ICU nurses, and were available in full text. The exclusion criteria included studies with mixed participants if separate analyses for nurses were not provided. Risk of bias was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for analytical cross-sectional studies, and a narrative synthesis was performed., Results: Five high-quality studies were included, involving 1,654 ICU nurses with an average age between 28.64 and 41.40 years, predominantly female (54.8 % to 91 %). Identified factors included nurses' personal factors, nurses' job characteristics, nurses' clinical competence in end-of-life care, and process of healthcare., Conclusions: The review highlights the vital factor influencing a good death from ICU nurses' perspectives. Awareness of personal and job-related factors, along with enhanced clinical competence in end-of-life care, are essential for supporting patients to achieve a good death., Implications for Clinical Practice: ICU nurses can enhance their clinical competence in end-of-life care. Hospital managers should take into account nurses' work experience when assigning staff and consider implementing fixed shifts. Future research should explore these factors globally and develop interventions to support a good death in the ICU., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Secondary traumatic stress is acknowledged as a substantial psychological risk factor in nursing practice with the potential to negatively impact nurses' mental health. However, little is known about the mechanisms underlying the spiritual climate and secondary traumatic stress among ICU nurses., Objectives: This study aimed to assess the spiritual climate, moral resilience, and secondary traumatic stress in Chinese ICU nurses and to investigate whether moral resilience mediates the relationship between spiritual climate and secondary traumatic stress., Methods: A cross-sectional study design was used to recruit 229 intensive care unit nurses. The nurses completed online questionnaires comprising demographic characteristics, spiritual climate, moral resilience, and secondary traumatic stress. Data analysis and structural equation modeling were conducted using SPSS 26.0 and AMOS 24.0., Results: STS scores were (38.42 ± 13.27). Secondary traumatic stress was correlated with spiritual climate and moral resilience (r 1  = -0.370, r 2  = -0.575; p < 0.01), and spiritual climate was positively correlated with moral resilience (r = 0.427; p < 0.01). A mediating effect of moral resilience between spiritual climate and secondary traumatic stress held (mediating effect of 0.235, 95 % CI: -2.108 to -0.823, accounting for 57.32 % of the total effect)., Conclusions: The spiritual climate has a significant direct influence on secondary traumatic stress in ICU nurses and serves to reduce their secondary traumatic stress through moral resilience. Creating a positive spiritual climate and enhancing the moral resilience of ICU nurses are effective methods to reduce their secondary traumatic stress., Implications for Clinical Practice: This study highlights that the spiritual climate for ICU nurses can reduce their secondary traumatic stress, and that moral resilience diminishes the secondary traumatic stress related to the spiritual climate. Establishing support systems and improving the environment are primary tasks for nursing administrators. These include, but are not limited to, improving the spiritual climate of the department, providing moral resilience training, and taking other measures to prevent and regulate secondary traumatic stress in ICU nurses in order to maintain their mental health., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objectives: This study explores the challenges and experiences faced by paediatric intensive care unit (PICU) nurses while caring for maltreated paediatric patients., Research Methodology/design: A qualitative study was conducted using face-to-face semi-structured interviews from February to May 2022. The data were transcribed verbatim and a simple thematic analysis was used., Setting: Twenty PICU nurses from National Taiwan University Children's Hospital were recruited through purposive and snowball sampling., Findings: Ten sub-themes were identified and synthesised into three primary themes: 'unstable nurse-patient relationships', highlighting the tensions and communication challenges between nurses, and the families of maltreated children and adolescents; 'insufficient pertinent competencies in handling child maltreatment', pointing to nurses' lack of sensitivity, experience, and requisite skills for addressing child maltreatment; and 'challenges in multidisciplinary team collaboration', which underscores nurses' feelings of being overwhelmed and apprehensions regarding the continuity of care as various professional teams are involved., Conclusion: PICU nurses face considerable stress while caring for maltreated children and adolescents. This can be attributed to unstable nurse-patient relationships, insufficient care-related competencies of nurses, and the complexities introduced by multidisciplinary team interventions. Therefore, priority actions include continuous in-service education, sharing pertinent professional experiences, enhancing nurses' sensitivity toward maltreatment, establishing standard operating procedures, and developing comprehensive case management systems and multidisciplinary expertise tailored to the needs of PICU nurses., Implications for Clinical Practice: Understanding the stressors and challenges encountered by PICU nurses in caring for maltreated children and adolescents can guide the design and implementation of interventions by current hospital decision-making bodies or child protection medical centres to enhance the clinical working environment. These interventions can aim to bolster the competencies of nurses and promote joint efforts in delivering superior medical care., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Cultural diversity is increasing worldwide. The provision of end-of-life care for people who have culturally diverse rituals, customs and beliefs can present barriers for critical care nurses in delivering high quality end-of-life care., Aim: To synthesise research evidence about the perceived barriers for critical care nurses providing end-of-life care for patients and their families from diverse cultural backgrounds in ICU., Research Question: What are the perceived barriers for nurses providing end-of-life care for patients and their families from culturally diverse backgrounds in ICU?, Design: Following protocol registration, a structured integrative review was undertaken across Medline, Embase, APA PsycINFO, CINAHL Complete, Cochrane library, Google Scholar and ProQuest Dissertation and Theses Global databases. A total of 823 records were independently assessed against inclusion and exclusion criteria. All included studies were assessed for quality. Narrative synthesis was used to report findings., Results: Fifteen studies published between 2010 and 2022 were included. Findings are presented according to four themes: (i) Language and communication, (ii) (Dis) Comfort with religion, (iii) Consensus challenges and (iv) Caring at the end of life., Conclusion: Recognising cultural diversity provides opportunity for critical care nurses to build awareness and understanding of cultural diversity as a way of optimising end-of-life care, through routine cultural assessment, advocating for professional interpreters to enhance communication and demonstrating openness to diverse cultural needs, preferences and practices., Implications for Clinical Practice: The obvious first step in countering perceived challenges to end-of-life care is to increase awareness by acknowledging and respecting difference and diversity. Cultural assessments for all patients admitted to critical care would be an ideal first step in addressing challenges associated with cultural diversity. Greater access to professional interpreters to overcome language barriers is also essential to optimising communication and consensus in decision-making at the end of life., Competing Interests: Declaration of competing interest Melissa J Bloomer is associate editor for Intensive & Critical Care Nursing and was not involved in the editorial review or the decision to publish this article. Kylie O'Neill has no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Background: Intensive care units (ICUs) are the primary producers of greenhouse gas emissions within hospitals, due to the use of several invasive materials. Nurses represent a large portion of the healthcare workforce and can be pivotal in promoting sustainability practices. Several international reports have suggested that nursing can help achieve the sustainable development objectives set by the United Nations., Aims: The purpose is to explore behaviour related to environmental sustainability in intensive care nurses., Study Design: A qualitative content analysis comprised of in-depth interviews involving 27 ICU nurses, who were each asked the same open-ended question. The transcripts collected were then analyzed and organized by a team of independently-working researchers. The analysis of the extrapolated concepts was carried out following the Neem M. (2022) method. The study is supported by a grant from the Centre of Excellence for Nursing Scholarship, Rome, July 2024., Findings: The main recurring themes are as follows: (1) concepts of environmental sustainability in ICUs, (2) critical issues related to sustainable intervention in the ICUs (3) proactive environmental sustainability attitudes in ICUs. Time to know, define criticality, and improve is the conceptualization of sustainable behaviors experienced by ICU nurses., Conclusions: Taking the time to know and define the critical issues for implementing sustainable behaviours in the ICU, turned out to be the key to enforce the mindset of green nursing thinking., Implications to Clinical Practice: Sustainability behaviours need to be proposed and verified by ICU managers by creating sustainability teams and promoting a good working environment, founding the progression to green ICUs by focusing on health impact education and mindfulness., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: The job performance of intensive care nurses is critical to the treatment and recovery of critically ill patients. Inclusive leadership, self-efficacy and organization-based self-esteem (OBSE) are important psychosocial factors affecting job performance. However, few studies have explored the relationships among these factors in critical care nurses., Aims: To examine the impact of inclusive leadership on the job performance of intensive care nurses and to explore the potential mediation through self-efficacy and OBSE., Methods: A cross-sectional survey design was employed. Between November and December 2023, a total of 460 intensive care nurses from China completed the survey, which included standard assessments on inclusive leadership, self-efficacy, OBSE, and job performance. Mediation analysis was conducted using structural equation modeling. Indirect effects were evaluated through bootstrapping., Results: The results indicated significant positive correlations among inclusive leadership, self-efficacy, OBSE, and job performance (all P < 0.01). Inclusive leadership not only directly affected the job performance of intensive care nurses but also influenced it through the partial mediating roles of self-efficacy and OBSE, with the mediating effects accounting for 14.29 % and 30.61 % of the total effect, respectively. Additionally, the analysis found that self-efficacy and OBSE played a chain mediating role in the relationship between inclusive leadership and the job performance, with the mediating effect accounting for 22.45 % of the total effect., Conclusions: Inclusive leadership positively predict the job performance of intensive care nurses. Self-efficacy and OBSE act as mediating factors, further explaining how inclusive leadership improves the job performance of intensive care nurses., Implications for Clinical Practice: Enhancing inclusive leadership can be achieved through targeted training programs that emphasize open communication, team collaboration, and recognition of diverse perspectives. For example, leadership workshops can include role-playing scenarios that promote active listening and constructive feedback. Furthermore, boosting self-efficacy and OBSE is essential, as these variables significantly mediate the relationship between inclusive leadership and job performance. Encouraging mentorship and providing opportunities for professional development can help nurses build their confidence and organizational identity, ultimately leading to improved performance and patient care outcomes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Purpose: The premenstrual symptoms (PMSs) are a common health issue affecting women of reproductive age and are associated with various physiological, psychological, and situational factors. Newly graduated nurses, when suddenly exposed to excessive workloads and shift work, may experience disturbances such as sleep disorders, fatigue, depression, and stress. These factors are related to PMS, and their occurrence varies. Therefore, this study aimed to understand the changes in PMS and its risk factors among newly graduated nurses across shift work periods, and investigate the longitudinal relationships between PMS and its risk factors based on the theory of unpleasant symptoms., Methods: This study constituted a secondary data analysis and employed a prospective longitudinal design. Newly graduated nurses were assessed three times: before starting shift work, six months after initiating shift work, and 18 months thereafter. Physiological (age, body mass index, alcohol consumption, dietary behavior), psychological (sleep quality, fatigue, depression, stress, life satisfaction), and situational (social support) factors were included as PMS-related factors., Results: PMS worsened six months after the initiation of shift work compared with those before, and this aggravation persisted even after 18 months of shift work (p < .001). Age (p = .043), sleep quality (p = .004), and fatigue (p < .001) were associated with PMS. An interaction between time and depression that affected PMS was observed (p = .021)., Conclusion: Newly graduated nurses need to pay attention to the exacerbation of PMS after initiating shift work. Interventions to improve sleep quality and reduce fatigue are crucial for novice nurses, irrespective of shiftwork duration. Additionally, it is important to assess depressive symptoms before starting shift work and implement early interventions. Furthermore, the need for interventions addressing depression escalates with the increase in shiftwork duration., Competing Interests: Conflict of interest The authors declare no conflicts of interest., (Copyright © 2024. Published by Elsevier B.V.)

Background: For nurses working in specialized units such as burn units, having adequate levels of job satisfaction and motivation is crucial for enhanced productivity in order to maintain quality nursing care., Methods: A cross-sectional, descriptive, correlational design was used in the study. The study aimed to investigate the job satisfaction and motivation levels of nurses working in burn units, the relationship between job satisfaction and motivation levels, and the influencing factors. The study sample consisted of 73 nurse managers/clinicians who worked in burn services or intensive care units in September and December 2023. The data were collected with "Demographic and work characteristics form," "Job Satisfaction Scale for Nurses (JSSN)", "Nurse Job Motivation Scale (NJMS)". Data were analyzed using Independent Samples T-test, One-Way ANOVA, and Mann-Whitney U tests to compare the descriptive characteristics of nurses and the scale scores. Correlation and regression analyses were conducted to reveal the relationship between the descriptive characteristics and scale scores of the nurses., Results: The mean age of the nurses was 30.26 ± 7.99 years, and 60.3 % were bachelor's degree graduates. The nurses had an average of 8.64 ± 8.25 years of experience in the profession and an average of 4.77 ± 5.39 years in the burn unit. The total score average for the NJMS was found to be 66.49 ± 5.56, and the JSSN score average was 3.46 ± 0.58. A weak negative relationship was found between the JSSN subscale "Suitable Support from Seniors" and age (p < 0.05), "Perceived importance at the job" and the working years in the burn unit (p < 0.05)., Conclusions: A positive correlation was observed between job satisfaction and job motivation of the nurses. If older nurses cannot get support from their supervisors, their satisfaction will be decreased. In addition, if more experienced nurses in the burn unit do not feel importance on the job, their satisfaction will be decreased., Competing Interests: Declaration of Competing Interest No conflicts of interest., (Copyright © 2024 Elsevier Ltd and International Society of Burns Injuries. All rights reserved.)

Objective: The integration of end of life care into emergency work is gaining momentum, especially in Australia. Emergency doctors and nurses are increasingly required to make decisions regarding the provision of end of life care. The importance of end of life care for patients and their families in the emergency department is well documented, but ethical dilemmas that arise in end of life care provision are not widely researched., Methods: A qualitative interpretative design and phenomenological approach were used to create an understanding and meaning about ethical dilemmas faced by emergency nurses and doctors in end of life care. Sixteen doctors and nurses were purposively recruited through professional organisations. Data were collected using semi-structured in-depth interviews. Interviews were audio-taped, transcribed verbatim, and thematically analysed using a qualitative seven stage thematic analysis., Results: The overarching constitutive pattern 'decision making processes' was conceptualised within the two identified major themes including: 1) Short-term (ST) versus Long-term (LT) ethical dilemmas and; 2) Individual versus community ethical dilemmas. These themes were uncovered using the phenomenological hermeneutic concepts of epoche (openness) to construct meaning and understanding for participants., Conclusions: In this study, the frequent experiences of ethical dilemmas by emergency doctors and nurses demonstrated that end of life care in the emergency department was challenging. The stated experiences were related to barriers that contributed to the complexities reported in making ethical decisions at the end of life. Therefore, an understanding of ethical principles is needed to navigate care for patients and their families for the best possible outcomes., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Occurrences of out-of-hospital emergencies (OHE) underscored the vital roles of bystanders yet nurses on some occasions may take on this role uninvolved., Methodology: This study employed a qualitative research design specifically a Husserlian Descriptive Phenomenology to explore the lived experience of nurses who became uninvolved bystanders in OHE., Results: Semi structured in-depth interviews with nine nurses revealed four central themes: (1) recognizing an ambiguous situation, (2) acknowledging the required competence and confidence, (3) dealing with negative emotions, and (4) caring for oneself and the victim., Conclusion: Nurses, as uninvolved bystanders, were confronted with an ambiguous situation which underscored their psychosocial needs. Even if societal expectations dictate nurses to take on an active role, at times being uninvolved in OHE reflects a 'caring individual' who balances professional knowledge, skills, and attitude resulting in the protection of patients and upholding personal welfare., Recommendations: There is a need to sufficiently and legally safeguard the welfare of respondents in OHE, and provide additional education and training to effectively manage OHE. Further research is recommended for policy development., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

This current study explored the relationship between challenge-hindrance stressors, coping style, and psychological resilience among rescue nurses caring for mass burn patients., Methods: This study is multicenter and cross-sectional. Registered nurses who saved and cared for extensively burned patients at two tertiary hospitals in mainland China between January and August of 2023 were selected through purposeful sampling. Online surveys were used to gather data. Multiple linear regression and Pearson correlation were used to examine the link between challenge-hindrance stressors, coping style, and psychological resilience., Results: 121 nurses completed the online questionnaires. The mean score for psychological resilience was 63.80 ± 11.63, for the challenge-stressor 16.23 ± 4.38, and for hindrance-stressor 9.85 ± 3.89. The total score for positive coping style was 23.69 ± 7.73, and that for the negative coping style 11.45 ± 5.21. Pearson analysis showed total resilience score was positively correlated with challenge stressors (r = 0.697, p＜0.05) and positive coping style (r = 0.616, p＜0.05), and negatively correlated with the hindrance stressors (r = -0.512, p＜0.05) and negative coping style (r = -0.589, p＜0.05) among rescuer nurses. Multiple linear regression analyses identified that having attended rescues before, challenge-hindrance, and coping style are the potential influencing factors of resilience., Conclusion: In mass burns accidents, rescuer nurses have a medium level of psychological resilience, which positively and significantly correlated with challenge stressors and positive coping style. It is suggested that more attention should be devoted to the target population to formulate effective intervention plans, reduce psychological impact, and improve their capacity for coping with disasters., Competing Interests: Declaration of Competing Interest There is no conflicts of interest have been declared by the authors. This work has not been submitted for publication in whole or in part elsewhere. The publication is approved by all authors., (Copyright © 2024. Published by Elsevier Ltd.)

Background: The relationship between empowering leadership, intrinsic motivation, and thriving at work among emergency department nurses is unclear. Thriving at work can raise employees' job satisfaction and lower their tendency to quit. High workloads and unpleasant workplace experiences may result in emergency department nurses thriving less at work. It has been demonstrated that intrinsic motivation and empowering leadership are both linked to thriving at work in employees., Aim: To investigate the relationship between empowering leadership and thriving at work among emergency department nurses, as well as the mediating function of intrinsic motivation in this relationship., Methods: The 337 emergency department nurses were polled using general information questionnaire, Empowering Leadership Scale, Intrinsic Motivation Scale, and Thriving at Work Scale. Structural equation modeling was used for data analysis., Results: Positive relationships existed between thriving at work and empowering leadership and intrinsic motivation. Intrinsic motivation was a mediator of the relationship between empowering leadership and thriving at work., Conclusions: Intrinsic motivation is one mechanism by which empowering leadership can influence emergency department nurses thriving at work. Nurse managers should adopt an empowering leadership style and take steps to activate the intrinsic motivation of emergency department nurses, thereby increasing nurses' ability to thrive at work., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objectives: Delirium is a common post-cardiac surgery complication that presents as acute changes in mental abilities with confused thinking and a lack of awareness of the surroundings. Delirium symptoms present in hyperactive- and hypoactive forms. Hypoactive delirium is often overlooked. Although nursing interventions are important in preventing and treating hypoactive delirium, studies focusing on nurses' experiences of hypoactive delirium are scarce. This study describes registered nurses' experiences of caring for patients with hypoactive delirium after cardiac surgery., Research Methodology/design: This was a qualitative descriptive study with an inductive approach. Data was collected through focus group interviews with 12 registered nurses with experience in caring for cardiac surgery patients with hypoactive delirium. The study complied with the Consolidated Criteria for Reporting Qualitative Research., Setting: A cardiac surgery department at a Swedish University Hospital., Findings: The analysis resulted in one main category; "Navigating the complexities of care when caring for patients with hypoactive delirium" and three sub-categories: "Challenges, "Nursing interventions" and "Promoting a team approach"., Conclusion: Delirium assessment and nursing interventions are perceived as essential yet demanding. when caring for patients with hypoactive delirium. Nursing interventions like maintaining the circadian rhythm and offering emotional support need to be prioritised by the nurses, in line with the autonomy of the registered nurse's profession. Moreover, the team around the patient is crucial for detecting and treating hypoactive delirium, and it is important to involve other professionals as well as the patient's relatives. Future research is needed to develop assessment instruments that more accurately capture hypoactive delirium in the postoperative setting., Implications for Clinical Practice: Despite the use of screening tools, nurses still experience challenges in detecting the symptoms of hypoactive delirium, indicating a need for more clinically effective screening tools for hypoactive delirium. Nursing interventions are emphasised in the care of patients with hypoactive delirium., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Objective: To determine the relationship between spiritual care and patient advocacy across three generations of nurses working in intensive care units., Design: Cross-sectional survey., Methods: Data collection took place from July to August 2022 with 120 nurses in Turkey. Data collection tools included the Spiritual Caregiving Competency Scale, the Spirituality and Spiritual Care Assessment Scale, and the Patient Advocacy Scale for Nurses. Data on nurses' demographics were evaluated using descriptive statistical methods (number, percentage, mean, standard deviation). Independent sample t-test, one-way ANOVA, Pearson correlation, and linear multiple regression analysis were used to evaluate the relationships between variables, with results reported as 95% confidence intervals (CI)., Results: More than half of the nurses were from Generation Y (39.2 %) and Generation Z (42.5 %). Generation Z's mean patient advocacy score (156.96 ± 23.16) was statistically significantly higher than Generation X's (139.32 ± 34.26). We determined that the spiritual competence scale communication sub-dimension score of Generation Y nurses working between 1-10 years was higher than that of Generation Z nurses. Additionally, as the patient advocacy scores of all generations increased, so did spiritual competence scores., Conclusion: The study found differences in patient advocacy and spiritual care competencies between generations. Thus, we recommend organizing courses, seminars, and in-service training on patient advocacy and spiritual care for intensive care nurses., Implications for Clinical Practice: This study estimates nurses' spiritual care competencies and patient advocacy levels from different generations and sheds light on the literature to eliminate differences in care between generations in nursing practices that evolve and change over time. It is recommended that courses, seminars, in-service training, spiritual activities, and interactive meetings be organized to encourage the participation of intensive care nurses to minimize the differences in spiritual care and patient advocacy among all generations of intensive care nurses., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Pain is a distressing problem which commonly occurs among critically ill patients. Nurses' knowledge of, attitudes, and perceived barriers to pain assessment and management can influence the effectiveness of nursing care., Objective: To explore the current knowledge of, attitudes, and perceived barriers to pain assessment and management among Thai critical care unit nurses., Methods: A cross-sectional survey conducted between November 2022 and January 2023 among 158 Thai nurses working in one of eight adult critical care units in a tertiary hospital, evaluated their knowledge of, attitudes, and perceived barriers to pain assessment and management., Results: Nurses possessed inadequate knowledge and negative attitudes regarding pain assessment and management. The most important barrier to pain assessment and management was "patients are unable to communicate their pain". The results showed a significantly weak positive correlation between nurses' attitudes toward pain assessment and management age (r = 0.26, p = 0.001), year of ICU experience (r = 0.29, p < 0.001), and obtaining a certificate in intensive care nursing (r = 0.37, P < 0.001)., Conclusions: Thai critical care unit nurses possessed inadequate knowledge and negative attitudes. Further training and education regarding pain assessment and management could include case studies or simulation and immersive virtual reality to improve critical care unit nurses' knowledge and attitudes as well as identifying potential barriers to pain assessment and management in the critical care settings., Implications for Clinical Practice: The implications for clinical practice recommend that continued quality assurance procedures should be implemented and maintained to evaluate the effectiveness of current pain assessment practices. Additionally, the perceived barriers to effective pain assessment and management should be considered and managed not only through continued education and training but could include using nursing case review, morbidity and mortality data identifying those patients that experience chronic pain post-ICU discharge., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Objectives: Doctors and nurses suffer different mental health conditions following traumatic incidents. We systematically synthesized existing evidence on the prevalence of anxiety, depression, and post-traumatic stress disorder (PTSD) and their associated risk factors among doctors and nurses following mass casualty incidents (MCIs)., Study Design: Systematic review., Methods: Seven databases were searched (2010-2022) with peer-reviewed articles in English using the predefined keywords. Two reviewers screened the titles, abstracts, and full texts using the eligibility criteria and extracted data independently. We used the National Institutes of Health Quality Assessment Tools (NIH-QAT) and the Critical Appraisal Skills Programme checklist (CASP) to measure the quality appraisal of the included studies., Results: A total of 5170 articles were retrieved, and 2512 articles were assessed by title and abstract (53 were eligible for full-text review). Finally, we included 19 studies. Most were assessed as of fair quality with a considerable risk of bias. PTSD was the highest-reported mental health condition. Nurses reported higher mental conditions, particularly PTSD. Two sets of risk factors (personal and workplace) are associated with anxiety, depression, and PTSD were found., Conclusions: MCIs have a significant impact on the mental health outcomes of emergency health workers. Preventive measures should be designed considering the high-risk group, personal, and organizational risk factors of mental health outcomes., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Problem: There is little documented evidence regarding the practice of midwives providing care for women with acute concerns in early pregnancy (< 20 weeks) in Australia., Background: Women can experience unexpected complications at any gestation of pregnancy and may seek acute care in an emergency or gynaecology service, usually staffed by registered nurses (RNs). They may not receive care from specialised pregnancy clinicians, including midwives. The role and scope of practice of midwives working in acute early pregnancy settings in Australia has not been previously reported. This study provides an opportunity to document practice in an area of pregnancy care not often visible within maternity services in Australia., Research Aim: To describe midwives' and RNs perceptions, perspectives and experiences of role and scope of practice in acute early pregnancy care provision in Australia., Methods: A qualitative descriptive approach was adopted. Midwives and RNs with acute early pregnancy knowledge and experience were recruited. Semi-structured interviews were conducted, and data analysed using inductive thematic analysis., Findings: Fifteen participants were interviewed. Three themes were constructed from interview data: Personal and Professional Influences; Being There for Women; The Impact of Setting., Discussion: Findings reinforce the lack of clarity around how midwives' scope is enabled in traditional acute early pregnancy care. Setting of care has influenced practice and seen a barrier for midwives who don't hold nursing registration from fulfilling professional scope. Results provide novel benchmarking evidence regarding a largely hidden area of midwifery, signposting areas for reform within education, policy and health service sectors., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest in this project., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Emergency triage, which involves complex decision-making under stress and time constraints, may suffer from inaccuracies due to workplace distractions. A serious game was developed to simulate the triage process and environment. A pilot study was undertaken to collect preliminary data on the effects of distractors on emergency nurse triage accuracy., Method: A 2 × 2 factorial randomized controlled trial (RCT) was designed for the study. A sample of 70 emergency room nurses was randomly assigned to three experimental groups exposed to different distractors (noise, task interruptions, and both) and one control group. Nurses had two hours to complete a series of 20 clinical vignettes, in which they had to establish a chief complaint and assign an emergency level., Results: Fifty-five nurses completed approximately 15 vignettes each during the allotted time. No intergroup differences emerged in terms of triage performance. Nurses had a very favorable appreciation of the serious game focusing on triage., Conclusion: The results show that both the structure of our study and the serious game can be used to carry out a future RCT on a larger scale. The lack of a distractor effect raises questions about the frequency and intensity required to find a significant impact on triage performance., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Introduction: In EDs, triage ensures that patients whose condition requires immediate care are prioritized while reducing overcrowding. Previous studies have described the manifestation of caregivers' moral judgements of patients in EDs. The equal treatment of patients in clinical practice presents a major issue. Studying the impact of prejudice on clinical practice in the ED setting provides an opportunity to rethink clinical tools, organizations and future training needs. Our study sought to describe the moral judgements expressed by triage nurses during admission interviews in emergency departments and to assess their impact on patient management., Methods: An exploratory sequential mixed-method study was performed. The study was conducted between January 1, 2018, and February 18, 2018, in the EDs of three French hospitals. Five hundred and three patients and 79 triage nurses participated in the study. Audio recordings, observations and written handover reports made by nurses during admission triage interviews were analyzed with a view to discerning whether moral judgements were expressed in them. We studied the impact of moral judgements on patient management in the emergency department., Results: Abstract Moral judgements were made in 70% of the triage situations studied (n=351/503). They could be classified in seven categories. Patients were more likely to be subjected to moral judgements if they were over 75 years old, visibly disabled or if they had visible signs of alcohol intoxication. Being subjected to moral judgement was associated with differential treatment, including assignment of a triage score that differed from the theoretical triage score., Conclusion: More than two thirds of patients admitted to EDs were triaged using moral criteria. Patients who were morally judged at the admission interview were more likely to be treated differently., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Workplace violence can threaten the physical and mental health of emergency nurses, increasing their mobility and burnout rates. However, little research has focused on how to mitigate the negative effects of workplace violence., Objectives: To investigate the relationships among resilience scores, perceived organizational support, and workplace violence and to explore the mediating role of perceived organizational support in the relationship between resilience scores and workplace violence among emergency nurses., Research Design: A quantitative, cross-sectional study., Methods: From June to July 2023, 466 valid questionnaires were collected via the WeChat app Credamo Seeing Numbers. Participants were assessed using the Connor-Davidson Resilience Scale, the Perceived Organizational Support Scale, and the Fear of Future Violence at Work Scale., Ethical Consideration: The study was approved by the Ethics Committee of Hunan Normal University (No. 2023-389)., Findings: The Connor-Davidson resilience scores of emergency nurses were negatively associated with workplace violence and positively associated with emergency nurses' perceived organizational support. Emergency nurses' perceived organizational support was negatively associated with workplace violence. Perceived organizational support moderated the relationship between Connor-Davidson resilience scores and workplace violence among emergency nurses to some extent., Discussion: High levels of Connor-Davidson resilience scores can mitigate the negative effects of workplace violence. Perceived organizational support can increase with increasing levels of Connor-Davidson resilience scores. When nurses face workplace violence, support from the organization can, on the one hand, reduce the negative impacts of stress and, on the other hand, elicit positive emotions., Conclusion: To mitigate the effects of workplace violence on emergency nurses, interventions aimed at both internal and external organizational conditions must be developed to establish a supportive environment that can increase emergency nurses' Connor-Davidson resilience scores and sense of perceived organizational support, and decrease workplace violence., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Osteoporosis and fragility fractures are set to rise with the global ageing population. Prevalence will continue to significantly impact people's quality of life and healthcare expenditure. Emergency nurses are ideally placed to highlight the importance of screening, and treatment, to the public. For emergency nurses to impart information to patients it is essential they have accurate, evidence-based knowledge. This study aims to determine if emergency nurses' knowledge of osteoporosis is sufficient to educate the public., Method: A cross sectional descriptive design of 210 emergency nurses using the 'Osteoporosis Knowledge Questionnaire' (OKQ) was administered in four hospitals in the West of Ireland. Data was analysed using SPSS v28., Results: A 66 % response rate was achieved. The mean score on the OKQ was 12.13 out of a possible 22. This suggests emergency nurses' knowledge of osteoporosis is substandard. Level of education has the greatest impact on participants (p = 0.005). Results indicated that emergency nurses acknowledge their responsibility regarding health promotion but lack the knowledge to undertake the role., Conclusion: Emergency nurses play a pivotal role in reducing osteoporosis and fragility fractures, by disseminating information to patients on prevention and management. This study highlighted that educational initiatives are required to address the deficiencies amongst emergency nurses' understanding of osteoporosis. Enhancing knowledge will inevitably lead to increased public awareness in tackling this global health crisis., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objective: To explore intensive care unit (ICU) nurses' perceptions of their adherence to pressure injury prevention clinical practice guideline and identify the perceived barriers and facilitators that influence evidence-based pressure injury prevention practices in Chinese tertiary hospitals., Research Methodology/design: This was a multi-site, quantitative, cross-sectional study. Data were collected using a self-report questionnaire with three sections: participant demographic information, adherence to pressure injury prevention clinical practice guideline, and barriers to and facilitators of pressure injury prevention clinical practice guideline implementation., Setting: Thirty-three adult ICUs in 16 tertiary general hospitals in 5 major cities in Liaoning Province, China., Results: In total, 473 nurses responded to the survey. The mean score for adherence to pressure injury prevention clinical practice guideline was 159.06 ± 20.65, with 65.3 % reporting good adherence. Multiple stepwise regression analysis indicated that smaller ICU size (β = -0.114, p = 0.012) and having participated in training on pressure injury prevention clinical practice guideline (β = 0.149, p = 0.001) were statistically significantly associated with better adherence. ICU nurses identified the low priority given to pressure injury prevention as the top barrier. The top three facilitators were awareness of evidence-based practice, the current documentation format for pressure injury risk/nursing interventions, and leadership support., Conclusion: ICU nurses' adherence to pressure injury prevention clinical practice guideline was satisfactory, and they reported low-to-moderate barriers and moderate facilitators., Implications for Clinical Practice: Participating in training on pressure injury prevention clinical practice guideline was a predictor of ICU nurses' adherence. Therefore, it is highly recommended that healthcare organisations consider providing training to nurses and address the barriers identified to improve nurses' adherence to evidence-based pressure injury prevention guidelines., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Background: Optimising sedation use is key to timely extubation. Whilst sedation protocols may be used to guide critical care nurses' management of sedation, sedation management and decision-making is complex, influenced by multiple factors related to patients' circumstances, intensive care unit design and the workforce., Aim: To explore (i) critical care nurses' experiences managing sedation in mechanically ventilated patients and (ii) the factors that influence their sedation-related decision-making., Design: Qualitative descriptive study using semi-structured interviews. Data were analysed using Braun and Clarke's six-step thematic analysis., Setting and Participants: This study was conducted in a 26-bed level 3 accredited ICU, in a private hospital in Melbourne, Australia. The majority of patients are admitted following elective surgery. Critical care nurses, who were permanently employed as a registered nurse, worked at least 16 h per week, and cared for ventilated patients, were invited to participate., Findings: Thirteen critical care nurses participated. Initially, participants suggested their experiences managing sedation were linked to local unit policy and learning. Further exploration revealed that experiences were synonymous with descriptors of factors influencing sedation decision-making according to three themes: (i) Learning from past experiences, (ii) Situational awareness and (iii) Prioritising safety. Nurses relied on their cumulative knowledge from prior experiences to guide decision-making. Situational awareness about other emergent priorities in the unit, staffing and skill-mix were important factors in guiding sedation decision-making. Safety of patients and staff was essential, at times overriding goals to reduce sedation., Conclusion: Sedation decision making cannot be considered in isolation. Rather, sedation decision making must take into account outcomes of patient assessment, emergent priorities, unit and staffing factors and safety concerns., Implications for Clinical Practice: Opportunities for ongoing education are essential to promote nurses' situational awareness of other emergent unit priorities, staffing and skill-mix, in addition to evidence-based sedation management and decision making., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: One author is an Associate Editor for Intensive & Critical Care Nursing and was not involved in the editorial review or the decision to publish this article., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

This integrative review is on emergency department nurses' perceptions on mental health patients waiting for placement. Seven articles met inclusion criteria. Themes included violence and patient safety, psychiatry and mental health support, attitudes and beliefs, education and training, emergency department workflow and environment, and long waits in the emergency department. Future research focusing on the care of mental health patients boarding in the emergency department is needed to address this issue. A limitation was that there were no focused studies on mental health boarders in the emergency department, and information had to be gleaned from articles on caring for mental health patients in emergency departments in general., Competing Interests: Declaration of competing interest The author declares that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Introduction: Nurses' sensitivity to moral issues, especially in emergency and intensive care units is essential for providing complex nursing care. Therefore, the present study aimed to determine the correlation between moral sensitivity and clinical competence in emergency and intensive care nurses., Methods: The present multi-center cross-sectional correlational study was conducted in 2022 on 180 nurses in five emergency departments and four intensive care units of general hospitals affiliated to Semnan University of Medical sciences. The study tools include a demographic questionnaire, 25 item Lutzen Moral Sensitivity Questionnaire (MSQ), and a standardized Competency Inventory for Registered Nurses (CIRN). Data were analyzed by mean, standard deviation and MANOVA, Pearson's correlation coefficient test., Results: The two groups did not have significant differences in demographic characteristics (p < 0.05). Majority of two emergency department nurses (83.9%) and Intensive care nurses (81.8%) had a moderate level of moral sensitivity. Also, clinical competence of majority of emergency department nurses (73.3%) and Intensive care nurses (75.8%) were in moderate level. There was significant positive relationship between moral sensitivity with Clinical competence in emergency department nurses (p ≤ 0.01, r = 0.61). No significant relationship was observed between moral sensitivity and the clinical competence of intensive care nurses (p > 0.05, r = 0.15)., Conclusions: There is need for improving the level of knowledge of nurses about moral principles and increasing moral sensitivity which can expand the components of clinical competence, especially in intensive care units., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Context: Malignant fungating wounds (MFWs) occur among 5%-15% of patients with terminal cancers, the uncontrollable symptoms result in serious psychosocial issues, thereby reducing the quality of life. Caring for MFWs impacts caregivers, including healthcare personnel. While existing studies are patient-focused, the impact of care experiences and associated support for nurses has not been examined., Objectives: To explore the experiences in caring for patients with MFWs among nurses in Taiwan., Methods: Qualitative study with a phenomenological approach by thematic analysis was conducted with semi-structured interviews. About 15 nurses who cared for patients with MFWs at local district hospitals in Southern Taiwan., Results: Four themes were identified to describe the phenomenon: (1) Fear of Unpredictability (2) Maintaining Professionalism (3) Feeling Helpless (4) Rationalizing the Negatives. The themes illustrated the distress of managing physical symptoms and highlighted how nurses strived to promote comfort for patients. Nurses felt helpless about the incurable nature of MFWs but found a way to suppress their feelings., Conclusion: The findings suggested the need for addressing the emotional well-being of nurses who take care of patients with MFWs. Future studies should identify effective coping strategies for nurses' health when caring for this population., (Copyright © 2024 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.)

Introduction: Obstetric emergency triage is a relatively new form of emergency triage and is not yet implemented in Sweden. Adaptations enables safe assessment of the childbearing woman, fetus and labor status. Failure to identify severely ill childbearing women and women post childbirth has repeatedly led to adverse outcomes. Introducing obstetric emergency triage constitutes a profound alteration in management that may challenge preconceived notions on how to provide best care. This study aimed at exploring and describing obstetric staff's experiences of working with obstetric emergency triage., Materials and Methods: Thirteen obstetricians, midwives and auxiliary nurses at an obstetric emergency department in eastern Sweden were recruited by purposeful sampling. Individual qualitative interviews underwent inductive qualitative content analysis according to Graneheim and Lundman., Results: An overarching theme - A new mindset - emerged from the analysis, comprising the four categories: Implications for the individual caregiver's own work, An improved organization, Improved patient care. Initial skepticism to triage changed towards a positive attitude during implementation, identifying barriers and facilitators for successful implementation., Conclusions: This first study exploring Swedish obstetric staff's perception of obstetric emergency triage as a working method suggests that, given time for implementation, a new mindset in obstetric emergency care might develop. Triage provides structure and a sense of control through a clear and quick overview of childbearing women seeking emergency care and enhances teamwork by improving communication. Triage directs attention toward aberrations and promotes reflection and action, improving patient safety., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Linnéa Lindroos was the lead creator of the Gothenburg Obstetric Triage System (GOTS) during 2016–2017. Prior to this study, GOTS was incorporated into the Rapid Emergency Triage and Treatment System. The other authors declare no conflict of interest., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Objective: To describe and analyse emergency nurses' experiences of caring for unidentified patients, and to provide a basis for constructing processes and standards of care for unidentified patients in the emergency department., Methods: This study is a descriptive phenomenological research that utilized purposive sampling. Sixteen emergency department nurses, who cared for unidentified patients between June and September 2023, were selected for semi-structured face-to-face interviews. Data were analyzed using Colaizzi's 7-step method to identify and refine themes., Results: Three themes were distilled: (1) increased workload, (2) increased mental stress at work, and (3) material needs and external environmental support., Conclusion: Emergency nurses have more complex negative emotional experiences when dealing with unidentified patients and want more external support to cope with such patients. Hospital administrators should pay full attention to nurses' caregiving experiences and provide positive interventions., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Thriving is a positive feeling arising from nurses' work and is increasingly valued by managers. Given their demanding workloads and various duties, it is necessary to research the determinants of ED nurses' thriving. This study aimed to investigate the factors influencing thriving and the mechanisms of interaction between the factors among ED nurses., Methods: 380 ED nurses from six tertiary hospitals in Shandong Province, China, participated in this cross-sectional study. The instruments used were the General Information Questionnaire, Challenge-Hindrance Stressors Scale, Psychological Detachment Scale, and Thriving at Work Scale. Data analysis methods included univariate analysis, Pearson correlation, PROCESS 4.0, and hierarchical multiple regression., Results: Weekly working hours affected nurses' thriving. Challenge stressors and psychological detachment were positively related to thriving. Hindrance stressors had a negative link with thriving. Psychological detachment suppressed the relationship between challenge stressors and thriving; however, it mediated the relationship between hindrance stressors and thriving., Conclusion: Challenge-hindrance stressors and psychological detachment are significant elements influencing ED nurses' thriving. Nursing administrators should help ED nurses properly address stressors with different attributes and adopt appropriate strategies to improve nurses' thriving by enhancing psychological detachment., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Aim: This study examined emergency nurses' and physicians' perceptions and self-assessed competence in caring for older patients., Methods: Data were analyzed using a mixed methods approach and quantitative data were supplemented with qualitative responses. There were 451 nurses and physicians working at the two examined emergency departments, with 125 of them responding to the survey; the response rate was 27.7 %., Results: Physicians and nurses felt that acutely ill older patients are a responsibility of emergency services. Nurses were more critical than physicians (p = 0.000) of the failure to recognize older patients as a special group at the emergency department. Over half (51.8 %) of the physicians and 29.0 % of the nurses (p = 0.027) felt that older patients' special needs had been considered during facility planning. Nurses and physicians described the problems related to multimorbidity and aging relatively similarly. Both expressed a need for more knowledge in geriatrics and gerontology., Conclusion: Future facility planning and care processes at the emergency department should better consider the specific needs of older patients. The results also emphasize a need to more effectively prioritize competence and educational needs of emergency staff and recognize caring for older patients as a specific competence area in the emergency department., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)