ABSTRACT
Background: Nigeria is a country with a heavy burden of global neonatal mortality caused by preterm births and low birth weight. Kangaroo Mother Care (KMC) is an established low-cost intervention that enhances the survival of babies and maternal outcomes, but its adoption and retention are of poor quality, despite a high level of policy support. Aim: This narrative review synthesises evidence on the benefits of KMC for mothers and infants in Nigeria and analyses the determinants of multilevel implementation using an implementation science approach. Methods: The search took place in PubMed, Scopus, and Web of Science databases by searching peer-reviewed articles that were published not older than 2025. Purposive sampling of evidence in Nigeria was done and synthesized using both the WHO KMC framework and CFIR. Findings: 12 studies were included in the study. KMC enhanced maternal psychological outcomes, thermoregulation, breastfeeding, and infection prevention, as well as survival. The limitations in implementation were a poor facility space, guidelines, inadequate provider training, poor leadership, socially held beliefs, the cost of hospitalization and support of the family. Conclusion: KMC's impact in Nigeria is effective, with an established impact, albeit with barriers to implementation. Recommendation: To achieve sustainable KMC scale-up and reduction in neonatal mortality, it is necessary to address the identified facility, workforce, leadership, sociocultural, and cost-related limitations.

ABSTRACT
Patient advocacy has long been recognized as a fundamental component of professional nursing practice. A comprehensive understanding of advocacy is essential for nurses to enhance patient safety and improve the quality of care. Despite its importance, several barriers may impede nurses’ ability to effectively advocate for patients. This study aimed to explore nurses’ perceptions of patient advocacy and identify barriers that hinder its implementation. Methodology: An exploratory descriptive cross-sectional design was employed. A convenience sampling technique was used to recruit nurses working in primary and secondary healthcare institutions in Al Dakhiliya Governorate, Oman. Data were collected using a structured questionnaire comprising demographic characteristics and the validated Protective Nursing Advocacy Scale (PNAS) developed by Hanks (2008). Descriptive and inferential statistical analyses were conducted using SPSS software. Results: A total of 129 nurses completed the survey, yielding a response rate of 25.8%. Most participants were female (88.4%), aged 31–35 years (38.8%), married (91.5%), and held a bachelor’s degree in nursing (53.5%). The findings indicated that nurses in Oman actively engage in patient advocacy. However, several barriers were identified, including limited clinical experience, fear of employer punishment, and concern about negative professional consequences. Conclusion: Advocacy remains an integral aspect of nursing practice. Therefore, nursing education programs should emphasize the development of advocacy competencies and integrate comprehensive advocacy content into curricula. Furthermore, healthcare institutions should establish clear advocacy policies outlining procedures and responsibilities, while implementing protective measures to safeguard nurses from professional, personal, and legal repercussions associated with patient advocacy.

ABSTRACT
Background: Assessment in nursing education combines continuous assessment scores (CAS) and examination scores (EXS) to evaluate student competence. While continuous assessment (CA) is intended to promote consistent learning and predict summative outcomes, limited evidence exists in Zambia on its impact on the final examination scores (FES). Objective: The general objective of the study was to examine the impact of continuous assessment scores on the final examination scores for student nurses examined between 2022 and 2024 at Eden University, Lusaka, Zambia, using a retrospective analysis of the July 2022 intake. Methods and Materials: A study employed a retrospective quantitative correlational study design in which a total of 15 courses were analysed by assessing the performance of students in each course and semester for the period of three years. This study used a semi-structured questionnaire in which a total population sampling technique was employed for the courses that were undertaken by the July 2022 intake for a period of three years. Data Analysis: Data was analysed using Statistical Package for Social Sciences (SPSS) version 26. The Pearson's correlation coefficient formula was used to calculate the correlation coefficient between dependent and independent variables. Conclusion: The analysis of continuous assessment scores (CAS) and final examination scores (FES) for student nurses at Eden University revealed a strong positive correlation between CAS and FES across most courses, indicating that students performing well in CAS tend to excel in FES. Overall, the study has shown that CAS is a good predictor of FES performance, emphasizing the importance of continuous assessments in identifying students who need support. Therefore, the study has revealed that CAS has a significant impact on FES for student nurses at Eden University in the School of Nursing and Midwifery Sciences (SoN & Mid Sc). It is against this study that there is a need to provide additio

ABSTRACT
Aim: This study was conducted to evaluate the knowledge levels of nurses working in children’s hospitals in Al-Hilla, Iraq, regarding pain management in children and to examine certain variables associated with knowledge levels. Method: This descriptive cross-sectional study was carried out with nurses working in pediatric units of three children’s hospitals in Al-Hilla. The study sample consisted of 255 nurses. Data were collected using the Introductory Information Form and the Nurses’ Knowledge Form on Pain Management in Children. Descriptive statistics and the chi-square test were used for data analysis. Results: The overall level of knowledge regarding pain management among nurses was found to be moderate. The lowest level of knowledge was identified in the subdimension related to nursing care for children experiencing pain. Statistically significant relationships were found between knowledge scores and educational level as well as the unit in which the nurses worked. Nurses working in pediatric emergency units, neonatal units, and pediatric intensive care units had higher knowledge scores. Conclusion: The results of the study indicate a need to improve the knowledge levels of nurses working in pediatric units regarding pain management. Strengthening structured educational programs and standard practice guidelines, particularly those focusing on nursing care and pain assessment, is recommended.

ABSTRACT
Patient advocacy is an ethical nursing practice, but its valid and reliable measurement remains problematic. The majority of existing scales lack robust psychometric evidence in diverse clinical environments. This study aimed to develop and psychometrically validate the Nursing Advocacy Scale (NAS-4), which is a multifaceted scale to measure challenges, strategies, and influencing factors on patient advocacy. The research was cross-sectional with 148 nurses. NAS-4 was applied, and the factorial structure of the NAS-4 was examined with Exploratory Factor Analysis (EFA). Internal consistency was assessed with Cronbach's alpha, and construct validity was assessed with known-groups validity and convergent validity analysis. EFA affirmed a four-factor solution for the core advocacy construct: 'Operational & Systemic Challenges,' 'Professional & Ethical Challenges,' 'Interpersonal & Social Challenges,' and 'Advocacy Action & Competency.' The overall scale and its subscales had high internal consistency (α = 0.78 to 0.92). Descriptive analysis of the items revealed that nurses strongly agreed that factors like supply and demand (M=4.49, SD=0.71) and ensuring patient safety (M=4.61, SD=0.75) were mandatory, while fear of losing one's job (M=3.13, SD=1.30) was a neutral challenge. Construct validity was established, with the scale differentiating well between groups with experience and training. The NAS-4 is a psychometrically sound instrument with proven reliability and validity for the measurement of the multifaceted construct of nursing advocacy. It is a valuable tool for health organizations and researchers to employ in the identification of barriers, audit of advocacy competency, and the development of effective targeted interventions to facilitate nurses as patient advocates.

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Despite progress in maternal health services, rural Zambia continues to record high rates of home delivery. Birth Preparedness and Complication Readiness (BPCR) is promoted to reduce delays in accessing skilled birth care, yet limited qualitative evidence exists on how preparedness influences actual delivery-site decisions among postpartum women. This qualitative study explored the role of birth preparedness in delivery-site selection among breastfeeding women in Petauke and Lusangazi districts, Eastern Province, Zambia. A descriptive phenomenological design was employed involving semi-structured interviews with 17 breastfeeding women who delivered at health facilities and four focus group discussions with 20 women who delivered at home. Data were analyzed thematically following Braun and Clarke’s approach. Birth preparedness emerged as the strongest determinant of delivery-site choice. Women who delivered at health facilities reported deliberate preparation including saving money, arranging transport, attending antenatal care, and preparing delivery items. In contrast, home delivery was associated with financial constraints, long distances, lack of emergency transport, cultural restrictions, limited decision-making autonomy, and low perceived risk. Strengthening birth preparedness particularly financial planning, transport readiness, male involvement, and community health education has high potential to increase institutional deliveries and reduce preventable maternal and neonatal risks in rural Zambia.

ABSTRACT
People living with mental illness are disproportionately affected by stigma in public environments and healthcare systems. Therefore, this quantitative correlational study aimed to explore the nurses’ attitudes towards people with mental illness in Oman. It also assessed the factors that influence nurses’ attitudes in providing health care in the Ministry of Health facilities. Additionally, this study examined the relationship between the demographic characteristics of nurses (age, gender, levels of education, years of nursing experience, and areas of nursing practice) and their attitudes towards people with mental illness. Methods: A total of 530 registered nurses, with a minimum of one year nursing experience, from Four governmental hospitals in Oman have participated in this study, and only 502 surveys were included in the study analysis. The participants were recruited via convenience and nonprobability sampling. The Opinions about Mental Illness Scale (OMI) and the Demographic Characteristics Questionnaire were used in the study. Results: A total of 530 registered nurses have participated in the study with a response rate of 94.7%. Demographic characteristics (age, levels of education, and years of nursing experiences) were significantly related to nurses’ attitudes towards people with mental illness. The findings of this study indicated that nurses who worked in mental health areas had more positive attitudes than nurses who worked in in other areas including medical-surgical and maternal and child health areas. Conclusion: Actions should be taken to foster positive attitudes towards people with mental illness, such as evaluating ways to do this in nursing curricula as well as incorporating programs to promote knowledge of mental health among practicing nurses, particularly general nurses.