Background Nursing students often experience psychosocial disturbance which affect their academic performance. This study examines the underlying mechanisms by how psychosocial disturbances predict academic amotivation and self-efficacy and influence academic performance.

Methods This is a cross-sectional study involved 164 undergraduate nursing students, using convenience sampling at the university in Hong Kong, SAR. To evaluate psychosocial disturbances, academic amotivation, self-efficacy and academic performance, Patient Health Questionnaire-9 (PHQ), General Anxiety Disorder-7 (GAD), Perceived Stress Scale-10 (PSS), Work and Social Adjustment Scale (WSAS), Academic Motivation Scale (AMS), and Student Self-Efficacy Scale (SSE) were administered, respectively. A self-developed rating scale was used to rate the satisfaction of the students towards the nursing curriculum. Cumulative Grade Point Average (cGPA) was adopted to evaluate academic performance. Structural equation modelling was conducted to quantify the pathways of the scores of PHQ, GAD, PSS, WASA, amotivation, program satisfaction, self-efficacy, academic amotivation and academic performance.

Results Significant indirect effects were observed from PHQ score (B = -0.004, p =.043) and GAD score (B = 0.004, p =.039) to academic performance via amotivation. Additionally, significant indirect effects from PSS to academic performance (B = -0.008, p =.009), WSAS to academic performance (B = 0.002, p =.027), and satisfaction with the program to academic performance (B = 0.01, p =.022) were observed via SSE. This indicates that amotivation and self-efficacy significantly mediate the path from the psychosocial disturbance, particularly depression, anxiety, stress, social adjustment and program satisfaction, to academic performance.

Conclusions The study findings indicate that nursing educators may identify students with psychological disturbances by observing their amotivation, low self-efficacy, and declining academic performance. They should develop and implement appropriate measures to detect these disturbances and support academic performance, with particular emphasis on amotivation and students perceived self-efficacy.

Background Nurses and nursing students frequently report feeling underprepared to manage aggressive patients and often lack confidence in verbal de-escalation skills. Although high-fidelity and standardized patient simulations are effective for teaching these competencies, learners may enter emotionally charged scenarios without adequate preparation. Virtual simulation games (VSGs) offer a potentially engaging, psychologically safe method of presimulation preparation, yet their impact in this context has not been examined.

Methods A quasi-randomized controlled study compared VSG-based presimulation preparation with traditional case-study preparation among fourth-year nursing students (N = 108) at a Canadian university. Students were assigned by simulation group to the experimental (VSG) or control (case study) condition. Knowledge, self-confidence, and anxiety were measured before and after preparation, and perceived competence was assessed before and after a standardized patient de-escalation simulation. Usability, engagement, and perceived impact on learning were evaluated using the ClassRoom Instructional Support Perception (CRISP) scale.

Results Knowledge improved significantly following preparation for both groups, with the VSG group showing significantly greater gains (p =.008). Self-confidence did not change significantly in either group, while anxiety increased over time in both groups (p =.003). Perceived competence improved significantly following the live simulation for all students, regardless of preparation method. VSGs were rated significantly higher than case studies for usability, engagement, and impact on learning (all p <.01).

Conclusions VSG-based presimulation preparation is feasible, highly acceptable, and associated with greater knowledge gains compared with traditional case-study preparation. While VSGs alone did not significantly influence self-confidence or anxiety, they appear to enhance cognitive readiness and learner engagement for emotionally demanding de-escalation simulations. Integrating VSGs into routine presimulation preparation may optimize in-person simulation efficiency and learning outcomes.

Objective To explore the current state of nursing pharmacology education in the United States and identify implications for strengthening nursing pharmacology education in Japan.

Methods Semi-structured interviews were conducted in July 2024 in Hawaii with three nursing professionals who had clinical and teaching experience in the United States. Thematic analysis was applied to categorize concepts related to nursing pharmacology education and clinical practice.

Results Five components were identified as essential in nursing pharmacology education: assessment ability, integration with anatomy/physiology/pathophysiology, simulation-based learning, active learning, and clinical medication experience. In clinical settings, key competencies included assessment ability, documentation, interprofessional collaboration, communication skills, clinical judgment, and accountability for patient safety.

Conclusions Findings from U.S. nursing pharmacology education suggest that strengthening assessment-centered, integrative, and experiential learning approaches may help enhance current nursing pharmacology education in Japan and prepare nurses to make safe medication-related clinical decisions.

ObjectiveThis study explored how nursing students in Austria perceive and communicate patient safety concerns during clinical internships and which individual and contextual factors influence their willingness to speak up.

Methods A multicenter cross-sectional survey was conducted between February and June 2024 at twelve universities of applied sciences in Austria. Nursing students completed a validated questionnaire assessing experiences with patient safety concerns, speaking-up behaviour, perceived barriers and enablers, and the clinical speak-up climate. Multivariate analyses were used to examine factors associated with speaking up and remaining silent.

Results Of 797 complete responses included in the analysis, 79% encountered safety concerns, yet 58\% withheld their voice at least once. Fear of negative consequences (62%) and uncertainty about reactions (51%) were the most common barriers. Prior healthcare experience was associated with higher vignette realism (p =.024) and lower discomfort (p =.017). Concern frequency strongly predicted both speaking up (OR = 3.54, p <.001) and withholding voice (OR = 5.89, p <.001). Psychological safety and an encouraging environment reduced withholding voice, whereas resignation increased the odds of both behaviors. Specialty effects were modest: students in neurology spoke up less (OR = 0.50, p =.027), while those in outpatient and long-term care withheld voice less (OR = 0.63, p =.038). Despite recognizing high risk in the vignette, students reported low likelihood of intervening.

Conclusions Nursing students frequently recognize patient safety risks but often do not act on them. This disconnect highlights the need for early educational interventions that strengthen communication skills, reduce fear, and counter resignation by fostering psychologically safe learning environments.

Objective To explore the application effect of a multidisciplinary collaborative Critical Care Ultrasound (CCUS) training system integrated with a mobile learning platform in improving nurses’ ultrasound assessment and mass casualty treatment capabilities during disasters.

Methods Targeting the fragmented application, non-standardized operation and interpretation of CCUS in primary hospitals, training needs were identified via research. A systematic training plan was developed, including expert lectures, question bank construction, video recording, development of a dual mobile platform (WeChat mini-program), and establishment of a standardized assessment system.

Results Post-training, trainees’ theoretical scores rose from (67.0 ± 8.5) to (83.2 ± 6.1) (p <.01); standardized operation scores increased significantly from (56.3 ± 10.2) to (89.1 ± 4.7) (p <.01); image interpretation accuracy improved from (74.1 ± 9.8)% to (92.3 ± 5.1)% (p <.01). A questionnaire survey showed 96.2% of trainees were satisfied or very satisfied with the training mode and mobile platform.

Conclusions The multidisciplinary collaborative CCUS training system combined with a mobile learning platform effectively enhances military medical personnel’s CCUS theoretical knowledge, operational standardization, and image interpretation ability. It significantly improves the efficiency of rapid and accurate assessment and disposal of mass casualties in disasters, with important application value and promotion significance for disaster rescue.

Procrastination is a common problem in academic contexts, affecting students' performance. To address this problem, the current research investigated its prevalence and factors among postgraduate diploma students. A cross-sectional design and a self-administered online questionnaire were used at the Higher Institute of Health Specialities. The study included all postgraduate diploma students in higher institute programmes. Data were analysed using SPSS Statistics. Findings showed that many Post Graduate Diploma students exhibited above-average levels of procrastination, especially on challenging tasks. Students were willing to reduce procrastination. Key factors included fear of failure, low motivation, task overload, and social influences. Factor analysis identified three main dimensions: risk-taking, fear of failure, and laziness. No significant link was found between procrastination and demographic variables.