Mohamed Hussein Ramadan Atta

Aim: To assess within‐group changes in dental anxiety, oral health knowledge and oral health behaviours following an oral health literacy intervention among older adults with dental diseases. Design: A non‐randomized one‐group pretest–posttest quasi‐experimental design. Methods: A convenience sample of 50 older adults participated in seven educational sessions addressing oral health, oral hygiene, nutrition, regular dental attendance and strategies for managing dental anxiety. Data were collected using the Saint Louis University Mental Status Examination, a sociodemographic questionnaire, the Oral Health Knowledge Scale, the Short Dental Anxiety Inventory and an oral healthcare behaviours questionnaire. Results: Following the intervention, participants had lower dental anxiety scores and higher oral health knowledge and oral health behaviour scores compared with baseline. Higher oral health knowledge was also associated with more favourable oral health behaviours. Conclusion: Lower dental anxiety and higher oral health knowledge and oral health behaviour scores were observed following the oral health literacy intervention among older adults with dental diseases. Because the study used a non‐randomized single‐group design, the findings should be interpreted cautiously. Implications for the Profession and/or Patient Care: Gerontological nurses can integrate oral health education and simple dental‐anxiety management strategies into routine care to support preventive oral health practices and engagement with dental services. Impact: Dental anxiety and limited oral health knowledge can hinder preventive dental care in later life. Following the intervention, participants had lower dental anxiety scores and higher oral health knowledge and oral health behaviour scores compared with baseline. The findings may inform nursing care for older adults in outpatient, primary care, community and long‐term care settings. Reporting Method: The study was reported in accordance with the Transparent Reporting of Evaluations with Nonrandomized Designs statement. No Patient or Public Contribution: Participants contributed study data but were not involved in the design, analysis, interpretation or manuscript preparation.

Background: Effective nursing handover is essential for ensuring patient safety and continuity of care, particularly in critical care settings where patients are highly complex and clinical decisions must be made rapidly. Occupational stress is prevalent among critical care nurses and has been associated with impaired performance and communication failures. Clinical decision‐making is a core professional competency that may influence how stress affects handover quality; however, limited evidence has examined its combined effects. Aims: To examine the impact of job stress and clinical decision‐making on handover competency among critical care nurses and to test the mediating role of clinical decision‐making in this relationship. Study Design: A multicentre cross‐sectional descriptive study was conducted in six hospitals in Egypt. Using a convenience sampling approach, participants completed self‐administered, self‐report questionnaires. Data were analysed using descriptive statistics, correlation analysis, multiple linear regression and mediation analysis with Hayes' PROCESS Macro (Model 4). Results: A total of 410 critical care nurses were recruited for the study. They reported moderate levels of job stress, strong clinical decision‐making abilities and high handover competency. Job stress was negatively correlated with both clinical decision‐making ( r = −0.242, p < 0.001) and handover competency ( r = −0.218, p < 0.001), while clinical decision‐making was positively correlated with handover competency ( r = 0.332, p < 0.001). Regression analysis showed that higher educational level, rotating shifts and stronger clinical decision‐making predicted higher handover competency, whereas higher job stress predicted lower competency. Mediation analysis revealed that clinical decision‐making partially mediated the relationship between job stress and handover competency, with significant direct, indirect and total effects. Conclusions: Clinical decision‐making plays a pivotal mediating role in the relationship between job stress and handover competency among critical care nurses. Job stress directly and indirectly impairs handover performance by diminishing nurses' decision‐making capacity. Relevance to Clinical Practice: Interventions aimed at reducing job stress and strengthening clinical decision‐making, such as stress‐management programs, simulation‐based training and structured handover protocols, may enhance communication quality and patient safety in critical care settings.

Aim: To examine the association between educational support and transition status among novice home healthcare nurses and to assess whether resilience shows an indirect association in this relationship. Design: A descriptive, cross‐sectional, correlational study was conducted with 215 novice nurses employed in home healthcare agencies. Methods: Data were collected using two standardized English instruments: the Educational Support Assessment Scale, the Transition Status Scale for Newly Graduated Nurses and the Arabic version of the Connor–Davidson Resilience Scale. Two instruments were translated into Arabic and culturally adapted for this study through forward–backward translation, expert panel review and pilot testing. Internal consistency and confirmatory factor analysis were used to examine reliability and preliminary construct validity. Descriptive statistics, Pearson correlations, linear regression and structural equation modelling were used to analyse the data. Results: Participants reported moderate to high educational support, high resilience and generally positive transition status. Active coping strategies and interpersonal integration were the highest‐rated transition dimensions, whereas work–life balance was the lowest. Educational support was positively associated with resilience and transition status. Resilience also showed a statistically significant indirect association between educational support and transition status. Because data were collected at one time point, this indirect pathway should be interpreted as an associative statistical model rather than evidence of causal mediation. Conclusions: Educational support, resilience and transition status were positively associated among novice home healthcare nurses. Resilience may be an important psychological factor linked to the relationship between educational support and transition status. Longitudinal studies are needed to confirm the temporal and causal nature of these associations. Implications for the Profession and/or Patient Care: Home healthcare agencies should provide structured educational support that combines clinical skill development with resilience‐building strategies, including guided reflection, mentoring, stress‐management training and peer support. Patient or Public Contribution: None.

Background: Although social interaction anxiety, resilience, and self-esteem have each been investigated among nursing students, limited research has examined whether resilience contributes to the association between social interaction anxiety and self-esteem through an indirect pathway during clinical practice. Addressing this gap may improve the understanding of the psychological factors associated with students’ adaptation in clinical settings. Therefore, this study aimed to examine the relationships among social interaction anxiety, resilience, and self-esteem and the indirect role of resilience among nursing students. Methods: Using a cross-sectional descriptive research design, the study sampled 880 nursing students from two Egyptian universities through stratified random sampling. Participants completed the Connor–Davidson Resilience Scale, the Rosenberg Self-Esteem Scale, and the Social Interaction Anxiety Scale. An observed-score path analysis was used to examine the direct paths and the indirect pathway through resilience. Results: Social interaction anxiety was negatively correlated with self-esteem (r = −0.409, p < 0.001) and resilience (r = −0.134, p < 0.001), whereas resilience was positively correlated with self-esteem (r = 0.597, p < 0.001). In the observed-score path model, social interaction anxiety was negatively associated with resilience (B = −0.13, p < 0.001) and self-esteem (B = −0.18, p < 0.001), while resilience was positively associated with self-esteem (B = 0.32, p < 0.001). The product of the two component paths was small (approximately −0.04) and is reported descriptively as an indirect pathway. Conclusions: Resilience was positively associated with self-esteem and accounted for a small indirect component of the cross-sectional association between social interaction anxiety and self-esteem. This finding should not be interpreted as evidence of statistically significant or causal mediation.

This pilot randomized controlled trial evaluated whether a Gagné's model‐based interactive desktop simulation program could reduce ageism and improve nursing students' attitudes toward older adult care. Hundred and twenty nursing students were randomized to an intervention group ( n = 60) receiving eight sessions combining Gagné's instructional events, desktop simulations, case discussions, and structured reflection, or a control group ( n = 60) receiving no intervention. Groups were comparable at baseline across all outcome measures (WEPS, FSA, PCOP‐SV; all p > 0.05). Post‐intervention, the intervention group demonstrated significantly greater improvement in willingness to work with older adults (WEPS), reduced ageist attitudes (FSA), and more positive perspectives on caring for older patients (PCOP‐SV), with statistically significant group‐by‐time interactions across all three outcomes sustained at follow‐up. A simulation‐enhanced instructional program based on Gagné's model shows promise for improving attitudinal outcomes in gerontological nursing education. Findings are preliminary and should be interpreted cautiously given the pilot design and complete‐case analysis. Trial Registration: ClinicalTrials.gov identifier: NCT0613947.

Previous studies highlighted the need for interventions addressing the psychological and social needs of older adults residing in institutional settings. To evaluate the effectiveness of PFA in reducing dignity-related distress, social frailty, and improving psychological resilience among institutionalized older adults. A randomized controlled trial (RCT) employing a two-arm, single-blind design was conducted among older adults residing in two assisted living facilities between December 2024 and March 2025. The required sample size was calculated using G*Power version 3.1.9.7, yielding a total of 80 participants. Participants were recruited from a pool of eligible residents through simple random sampling following eligibility screening and were subsequently allocated to either the intervention group (n = 40) or the control group (n = 40). Outcomes were assessed using the Makizako Social Frailty Index (SFI), the Resilience Evaluation Scale, and the Patient Dignity Inventory (PDI) at baseline (T0) and three months post-intervention (T1). At three months post-intervention, participants in the intervention group demonstrated significantly higher psychological resilience compared to the control group (Mdn = 28, IQR = 27-36 vs. Mdn = 8, IQR = 4.25-9) with a statistically significant difference (U = 149, Z = 6.302, p < 0.001, r = 0.70). Additionally, dignity inventory distress was significantly lower in the intervention group (Mdn = 40.50, IQR = 37-50) than in the control group (Mdn = 110.50, IQR = 104.25-114.00) with a statistically significant difference (U = 108, Z = 6.67, p < 0.001, r = 0.70). A significant difference was also observed in social frailty, with the intervention group reporting lower levels of frailty (Mdn = 0, IQR = 0-2) compared to the control group (Mdn = 4.00, IQR = 2.25-5.00), U = 179.00, Z = 6.12, p < 0.001, r = 0.68, indicating a large effect size. Psychological First Aid demonstrated effectiveness in reducing dignity-related distress and social frailty while enhancing psychological resilience among institutionalized older adults, highlighting its potential as a comprehensive psychosocial intervention, although further research is required to establish its long-term effectiveness and cross-cultural applicability.

Takotsubo syndrome (TTS), or ‘broken heart’ syndrome, is an acute, reversible cardiomyopathy classically linked to emotional stress. Although physiological mechanisms have been extensively described, the psychological stress profile of patients with TTS remains incompletely synthesised. This study aimed to systematically review and meta‐analyse observational studies examining psychological stress‐related factors in patients with TTS compared with cardiac and non‐cardiac control groups. We searched PubMed/MEDLINE, Embase, PsycINFO, Scopus, and Web of Science from 1 January 2011 to 31 March 2024 for observational studies of adults with TTS that used validated psychological assessments and included a cardiac or non‐cardiac comparison group. Two reviewers independently screened studies, extracted data, and assessed risk of bias with the Newcastle–Ottawa Scale. Random‐effects meta‐analysis pooled odds ratios (ORs) for study‐defined binary psychological endpoints, and comparator‐group subgroup analyses were treated as main analyses. Sixteen studies met the inclusion criteria, comprising 1133 patients with TTS and 1396 controls, including 1061 cardiac controls and 335 non‐cardiac controls. Across studies, patients with TTS showed higher rates of acute emotional triggers, lifetime mood and anxiety disorders, trauma history, maladaptive personality traits (e.g., neuroticism and Type D personality), and broader psychological distress, including posttraumatic stress symptoms, sexual distress, and reduced quality of life. The pooled OR for overall psychological morbidity/stress exposure was 6.50 (95% CI: 3.14–13.49), with substantial heterogeneity ( I ² = 84.1%). Comparator‐category subgroup analyses showed larger effects against acute coronary syndrome/acute myocardial infarction controls than against healthy volunteers alone. TTS is strongly associated with both acute emotional stressors and chronic psychological vulnerability, supporting models that conceptualise the syndrome as an extreme stress response of the cardiovascular system. These findings reinforce the value of routine psychosocial assessment and stress‐focused interventions in the care of patients with TTS.