Željko Mudri

Background/Objectives: Empathy is a fundamental element of nursing care. Differences in self-reported empathy across stages of nursing education may be related to educational advancement as well as to students’ age, employment status, and professional experience. Accordingly, this study examined self-reported empathy and its demographic, educational, and professional correlates among undergraduate and graduate nursing students. Methods: A cross-sectional survey included 201 nursing students in Osijek in 2025. The Jefferson Scale of Empathy—Health Professions Student version (JSE-HPS) was used. Exploratory group comparisons and regression analyses with HC3 robust standard errors were performed, with age entered continuously and work experience assessed separately. Results: The mean JSE-HPS score was 106.82 (SD = 14.21), and the median was 108 (Q1–Q3 = 95–118). The primary model included 200 students and explained 12.3% of the variance (adjusted R² = 0.123). Students in the reported female category had higher scores (B = 6.68, p = 0.003), whereas employed students had lower scores (B = −6.04, p = 0.014). Age and year of study were not statistically significant after adjustment. The employment association was not statistically significant in the model using categorized age and work experience. Conclusions: Female students consistently reported higher empathy scores, whereas the association with nursing employment varied across model specifications. Differences between academic stages were not statistically significant after adjustment. These findings highlight the need to consider students’ demographic and professional backgrounds when interpreting self-reported empathy in nursing education.

Background/Objectives: Loneliness among older adults is a public health concern associated with adverse health and well-being outcomes, yet evidence from eastern Croatia remains limited. This study examined social loneliness, family loneliness, and loneliness in romantic relationships among adults aged ≥65 years and their associations with sociodemographic, family, and social characteristics. Methods: This cross-sectional study included 431 community-dwelling older adults in Osijek-Baranja County from January to April 2025. Loneliness was assessed using the Croatian adaptation of the Social and Emotional Loneliness Scale. Group differences and correlations were examined using nonparametric methods, followed by separate multiple linear regression models with HC3 robust standard errors. Results: Median scores were 38 (29–47) for social loneliness, 20 (14–29) for family loneliness, and 41 (27–50) for loneliness in romantic relationships. Poorer perceived family-contact quality was associated with higher social and family loneliness in the adjusted models. Compared with good-quality contact, poor-quality contact was associated with social- and family-loneliness scores that were 19.66 and 25.52 points higher, respectively (both p < 0.001). Men and suburban residents had higher social loneliness in bivariate analyses, but sex and residence were not significant in the adjusted model. After adjustment for age, never-married, divorced, and widowed participants had romantic-loneliness scores 14.66, 21.55, and 15.58 points higher than married participants, respectively (all p < 0.001). Older age was weakly and positively correlated with social loneliness (ρ = 0.148; p = 0.002) and loneliness in romantic relationships (ρ = 0.194; p < 0.001). Family-contact frequency was not significant overall in the adjusted social and family loneliness models. Conclusions: Perceived family-contact quality and marital status were associated with distinct loneliness dimensions. Assessments should consider older adults’ experience of close relationships alongside contact frequency and structural indicators.

Background/Objectives: Missed nursing care threatens care quality and patient safety and may reflect modifiable organizational conditions. This systematic review and meta-analysis quantified the association between the nursing work environment and missed nursing care. Methods: PubMed, Scopus, Web of Science, and APA PsycInfo via EBSCOhost were searched from inception; searches were updated and finalized on 13 July 2026. Quantitative studies examining nursing work, professional, or practice environments in relation to missed, incomplete, unfinished, omitted, or implicitly rationed nursing care were eligible. The eligibility criteria, primary total-score Pearson correlation analysis, random-effects model with restricted maximum likelihood (REML) estimation, and direction harmonization were specified before inspection of the pooled results. Additional robustness and exploratory analyses were conducted post hoc, including Hartung-Knapp adjustment, leave-one-out and influence analyses, risk-of-bias and instrument-family sensitivity analyses, alternative correlation-metric analyses, meta-regression, and small-study-effect assessments. The review was retrospectively registered in the Open Science Framework on 25 August 2026 (DOI: 10.17605/OSF.IO/J62D3); no prospective protocol was available. Results: Forty studies were included. The primary meta-analysis comprised 15 studies and 7100 participants. A more favorable nursing work environment was associated on average with less missed nursing care (r = −0.301; 95% CI −0.402 to −0.192; p < 0.001; model-based I² = 95.7%). The 95% prediction interval ranged from −0.641 to 0.139 and crossed the null, indicating substantial uncertainty about the magnitude and potentially the direction of the association in a new setting. The association remained statistically significant with Hartung-Knapp adjustment (95% CI −0.411 to −0.182; p < 0.001), and no leave-one-out model changed its direction or statistical significance. Conclusions: On average, a more supportive nursing work environment was associated with less missed nursing care. However, the very high heterogeneity and a prediction interval crossing the null indicate substantial variation across settings. The pooled coefficient therefore represents an average association rather than a universal effect, and the predominantly observational evidence does not establish that modifying the work environment will causally reduce missed nursing care.

This study examined direct and indirect associations of Machiavellianism, narcissism, psychopathy, and sadism with suicidal ideation through depression, anxiety, and stress in psychiatric patients. A cross-sectional sample of 210 patients completed the Short Dark Tetrad (SD4), Depression Anxiety Stress Scales-21 (DASS-21), and Suicidal Ideation Attributes Scale (SIDAS). Regression paths were estimated using robust maximum likelihood, whereas indirect effects were evaluated using 10,000 bootstrap resamples. Because 92 participants (43.8%) had SIDAS = 0, two-part sensitivity analyses separated the occurrence from the severity of suicidal ideation; additional analyses excluded the two smallest diagnostic groups. Depression, stress, and anxiety correlated with SIDAS (r = 0.560, 0.509, and 0.466, respectively). The sadism–stress–SIDAS indirect effect was significant in the primary model (B = 0.147; 95% bootstrap CI [0.037, 0.291]), after covariate adjustment (B = 0.126; 95% bootstrap CI [0.016, 0.266]), and after excluding psychotic and bipolar groups (B = 0.115; 95% CI [0.006, 0.259]). In two-part analyses, depression was associated with SIDAS occurrence, whereas stress and sadism were associated with severity among participants with SIDAS > 0. The findings support a stress-related indirect association between sadism and suicidal ideation, but causal interpretation is not warranted.

This chapter explores age stigmatization towards older adult patients in healthcare as a socially constructed phenomenon shaped through interaction, institutional practices, and broader cultural values. Drawing on symbolic interactionism and Goffman’s concept of stigma, the chapter analyses age-related stigma across micro, meso, and macro levels, with particular emphasis on healthcare. In addition to the theoretical framework, the chapter incorporates selected findings from a quantitative study conducted among 468 nursing students, examining the relationships between age stigmatization, attitudes towards death, and value orientations. The findings indicate moderate levels of age stigma among nursing students. Higher levels of stigmatization were associated with fear and avoidance of death, whereas lower levels were associated with self-transcendence, benevolence, universalism, religiosity, and educational and professional experience related to older adults. The chapter argues that age stigmatization cannot be understood solely as an individual prejudice but should be interpreted as a socially reproduced process embedded in socialization, institutional structures, and cultural meanings of ageing and mortality. These results underscore the potential value of integrating educational, experiential, and value-oriented approaches in interventions aimed at reducing ageism among nursing students. Further longitudinal and experimental studies are needed to clarify the directionality and underlying mechanisms of these relationships.

Introduction: With population ageing, there is an increasing need for a holistic approach to healthcare for older adults, with spiritual needs representing an important but often under-researched aspect. Therefore, this study aimed to examine the level of spiritual needs among older adults receiving community nursing care in Osijek-Baranja County. Methods: A cross-sectional study was conducted with a convenience sample of 175 people aged 65 years and older who used the services of the Community Nursing Service of the Health Center of Osijek-Baranja County. Data were collected using a paper-and-pencil survey comprising the standardized Spiritual Needs Questionnaire and a sociodemographic questionnaire. Results: The most pronounced spiritual needs among the respondents were the needs for giving and inner peace, while existential needs were the least pronounced (P < 0.001). Women reported higher Inner Peace (P = 0.010), Existential (P = 0.030), and Religious Needs (P = 0.001). Participants belonging to a religious community reported higher Inner Peace (P = 0.030), Giving/Generativity (P = 0.008), and Religious Needs (P < 0.001). Age was negatively associated with Inner Peace (P = 0.010) and Giving/ Generativity Needs (P = 0.010), whereas self-rated religiosity was positively associated with all dimensions (P ≤ 0.008), particularly Religious Needs (P < 0.001). Conclusion: Older adults receiving community nursing care demonstrated substantial spiritual needs, especially those related to generativity and inner peace. These findings emphasize the importance of incorporating spiritual care into nursing practice and the broader healthcare of older adults.

Background/Objectives: Empathy is an important professional attribute in nursing and may be influenced by demographic, educational, and professional characteristics. This study aimed to assess empathy levels and examine demographic, educational, and professional factors associated with empathy among undergraduate and gradu-ate nursing students in Croatia. Methods: A cross-sectional study was conducted in 2025 among 201 nursing students at the Faculty of Dental Medicine and Health Osi-jek. Empathy was assessed using the Jefferson Scale of Empathy–Health Professions Student version (JSE-HPS). Group differences were examined using nonparametric tests. Multiple linear regression with heteroskedasticity-consistent HC3 standard errors was used for the primary multivariable analysis, with sensitivity analyses us-ing alternative model specifications and bootstrap confidence intervals. Results: The total JSE-HPS score was M = 106.82 ± 14.21 and Mdn = 108 (Q1–Q3 = 95–118). Signifi-cant unadjusted differences in empathy were observed according to gender, chrono-logical age, educational level, year of study, employment status, and years of work experience. In the primary HC3 model, female gender remained significantly associ-ated with higher empathy scores (B = 6.12, p = 0.013), whereas employment status was not statistically significant (p = 0.176). The primary model explained 11.5% of the variance according to adjusted R². The association of female gender with higher em-pathy remained consistent in sensitivity analyses; lower scores among employed stu-dents were supported in sensitivity and bootstrap analyses but were not consistent across all model specifications. Conclusions: Female gender showed a consistent asso-ciation with higher empathy scores, whereas the association with employment status was sensitive to model specification. These cross-sectional findings support continued attention to empathy throughout nursing education and warrant further longitudinal and multicenter research.

Background/Objectives: Loneliness among older adults is a public health concern associated with adverse health and well-being outcomes, yet evidence from eastern Croatia remains limited. This study examined social loneliness, family loneliness, and loneliness in romantic relationships among adults aged ≥65 years and their associations with sociodemographic, family, and social characteristics. Methods: This cross-sectional study included 431 community-dwelling older adults in Osijek-Baranja County from January to April 2025. Loneliness was assessed using the Croatian adaptation of the Social and Emotional Loneliness Scale. Group differences and correlations were examined using nonparametric methods, followed by separate multiple linear regression models with HC3 robust standard errors. Ordinal McDonald’s omega coefficients ranged from 0.863 to 0.919. Analyses were performed using R, version 4.6.1. Results: Median scores were 38 (29–47) for social loneliness, 20 (14–29) for family loneliness, and 41 (27–50) for loneliness in romantic relationships. Poorer perceived family-contact quality was associated with higher social and family loneliness in the adjusted models. Compared with good-quality contact, poor-quality contact was associated with social- and family-loneliness scores that were 19.66 and 25.52 points higher, respectively (both p < 0.001). Men and suburban residents had higher social loneliness in bivariate analyses, but sex and residence were not significant in the adjusted model. After adjustment for age, never-married, divorced, and widowed participants had romantic-loneliness scores 14.66, 21.55, and 15.58 points higher than married participants, respectively (all p < 0.001). Older age was weakly associated with social and romantic loneliness. Family-contact frequency was not significant overall in the adjusted social and family loneliness models. Conclusions: Perceived family-contact quality and marital status were associated with distinct loneliness dimensions. Assessments should consider older adults’ experience of close relationships alongside contact frequency and structural indicators.

Introduction/Objective: Patient satisfaction with nursing care quality is an important patient-reported indicator of hospitalization experience. Previous studies have mainly examined sociodemographic, clinical, and organizational factors, while personality traits have rarely been included in explanatory models. This study examined the association of sociodemographic characteristics, hospitalization-related variables, and personality traits with patient satisfaction. Methods: A single-center cross-sectional study was conducted among hospitalized patients in a general hospital in Croatia. Data were collected at discharge using a demographic and hospitalization questionnaire, the NEO Five-Factor Inventory, and the Croatian version of the Patient Satisfaction with Nursing Care Quality Questionnaire. Group differences were analyzed using non-parametric tests, and hierarchical regression analysis was performed. Results: Younger age, employment, male gender, and better self-rated health were associated with higher satisfaction. Patients admitted on a scheduled basis and those staying alone or with one other person in the room were more satisfied. Sociodemographic variables explained 21.5% of the variance in satisfaction (R² = 0.215; adjusted R² = 0.168). After hospitalization-related variables were added, the explained variance increased to 30.1% (R² = 0.301; adjusted R² = 0.232). The addition of personality traits further increased the explained variance to 45.6% (R² = 0.456; adjusted R² = 0.385). In the final model, staying with two or more persons was negatively associated with satisfaction, whereas agreeableness and conscientiousness were positively associated with satisfaction. Conclusions: Patient satisfaction with nursing care quality was associated with patient characteristics, hospitalization conditions, and personality traits. Accommodation conditions and individual psychological differences should be considered when interpreting satisfaction as an indicator of nursing care quality.

Rotating shift work is a common occupational stressor among healthcare professionals. This study aimed to examine the impact of shift work on sleep quality and cortisol levels among nurses. A prospective observational study was conducted in Croatia in 2025, involving 140 nurses. Sleep quality was assessed using the Fitbit Charge 3 smartwatch over eight consecutive days, and blood cortisol was measured at two time points. Most nurses (98.6%) had a neutral chronotype. Nurses who work day shifts (DSN) achieved significantly higher sleep scores compared with rotating-shift nurses (RSN) (77, IQR 75–80 vs. 73, IQR 68–76; Mann–Whitney U test, p < 0.001). RSN also had significantly higher morning cortisol levels at the first measurement (median 431.6, IQR 351.3–496.2 vs. 355.15, IQR 254.9–434.2) nmol/L; p < 0.001). In the RSN group, morning cortisol levels at the first measurement were positively correlated with age and years of service, and negatively correlated with circadian rhythm. Smartwatch-based assessments demonstrated that rotating shift work is associated with poorer sleep quality and transient disruption of cortisol regulation. Notably, cortisol levels in rotating-shift nurses returned to levels comparable to those of DSN after two nights of rest, indicating substantial reversibility of the hormonal response. These findings highlight the short-term physiological impact of shift work and underscore the importance of optimizing work schedules and implementing strategies to reduce long-term health risks.