The research, conducted by a team of Egyptian nursing scientists, focused on novice home healthcare nurses in Sharqia Governorate, a region in Egypt’s Nile Delta where demand for community-based care is rising sharply, driven by chronic disease, disability, and post-hospitalization support needs. Unlike their hospital-based counterparts, home healthcare nurses work largely alone, inside patients’ homes, making early decisions with limited immediate backup from peers or supervisors. They must communicate directly with patients and families, juggle multiple households and care needs, and exercise a degree of autonomy that most new graduates in institutional settings never encounter so soon. That independence, the researchers reasoned, makes the transition to practice in home care uniquely sensitive to both the quality of organized educational support and the individual nurse’s psychological adaptation.

To unpack that relationship, the team surveyed 215 novice home healthcare nurses—registered nurses in their first years of home care practice—using a cross-sectional, correlational design reported according to the STROBE guidelines. The sample size was calculated in advance with Epi Info 7 to detect a small-to-moderate correlation, and the final dataset comfortably exceeded the thresholds suggested by simulation studies for the mediation analyses that followed. Three standardized instruments anchored the study: the 10-item Connor–Davidson Resilience Scale to measure the capacity to cope with and recover from adversity; the Educational Support Assessment Scale for Novice Home Healthcare Nurses, which captures acquiring new knowledge, concrete experience, reflective observation, and managerial support; and the Transition Status Scale for Newly Graduated Nurses, a 38-item measure spanning interpersonal integration, active coping strategies, profession-related positive emotions, competence for nursing work, and work–life balance.

Because the original scales had been developed in English and Chinese contexts, the researchers undertook a rigorous translation and cultural adaptation process. Two independent bilingual translators produced Arabic versions—one with a nursing background to safeguard conceptual accuracy, one a linguist to ensure natural phrasing—followed by back-translation by two further translators blind to the originals. An expert panel of nursing academics, a clinical nurse specialist in home healthcare, and a bilingual language expert then reviewed every item, and a pilot test with 20 nurses outside the final sample refined wording and confirmed internal consistency. The Arabic versions performed strongly: Cronbach’s alpha reached 0.91 for the resilience scale, 0.89 for educational support, and 0.90 for transition status.

The statistical machinery behind the study was correspondingly thorough. Confirmatory factor analyses, estimated with diagonally weighted least squares to handle the ordinal questionnaire items, tested whether the multidimensional instruments could legitimately be summarized by overall scores. The educational support scale showed acceptable fit as a second-order model, with its four dimensions loading strongly onto a higher-order factor. The transition status scale showed marginal-to-acceptable fit, with all five dimensions loading significantly. The resilience scale’s one-factor model was more marginal, a caveat the authors acknowledge. With measurement established, the team ran partial correlations controlling for a battery of demographic and professional covariates, and then a structural equation model with 5,000 bootstrap resamples and bias-corrected confidence intervals.

The results were strikingly consistent. Educational support correlated positively with resilience (partial r = 0.539) and with transition status (partial r = 0.639), while resilience itself correlated with transition status (partial r = 0.614), all at p < 0.001. In the structural model, educational support showed a significant direct effect on transition status (β = 0.38) and a significant effect on resilience (β = 0.48), which in turn predicted transition status (β = 0.43). Crucially, the indirect pathway from educational support through resilience to transition status was significant (β = 0.21, 95% confidence interval 0.13 to 0.29), yielding a total standardized effect of 0.59. Because both direct and indirect paths held, the findings point to a partial indirect association: resilience carries part, but not all, of the relationship between training and successful adaptation.

The descriptive data added texture to the headline result. Male nurses reported considerably higher resilience and transition status than female nurses, and single nurses reported higher resilience than their married colleagues. Diploma holders outperformed bachelor’s and master’s degree holders across all three outcomes, and nurses with prior specialized training in home healthcare scored significantly higher on every measure. Those working more than 60 hours per week showed higher resilience and transition status, and nurses employed by private agencies rated themselves higher on both than those in public agencies. None of these factors, however, eliminated the core associations among educational support, resilience, and transition status, which survived adjustment for sex, education level, prior training, working hours, and agency type.

The authors interpret their findings through the lens of established occupational psychology. In the job demands–resources model, employee adjustment depends on both organizational resources—such as structured learning opportunities—and personal resources, such as resilience, hope, optimism, and self-efficacy. Educational support, in this framing, is the organizational resource: planned learning experiences that reduce uncertainty, build perceived competence, and help novices process difficult clinical situations. Resilience is the personal resource that converts that support into adaptive capacity. The study also aligns with broader workplace adaptation research, which holds that successful newcomer adjustment involves role clarity, self-efficacy, social acceptance, and coping—dimensions mirrored in the transition status scale’s own subscales of interpersonal integration, active coping, and professional emotion.

The practical implications are concrete. The authors argue that educational programs for novice home healthcare nurses should not be confined to clinical knowledge and technical skills. Agencies could incorporate resilience-building components—structured preceptorship, guided reflection after difficult home visits, case-based learning, stress-management sessions, peer-support groups, and regular feedback meetings with supervisors—while monitoring novices’ adaptation during the first months of practice and intervening early when confidence, coping, or work–life balance falter. In a setting where nurses may be granted early independence with little immediate supervision, integrating clinical learning with adaptive coping strategies could make the difference between a nurse who thrives and one who burns out.

The team is careful about the limits of what can be claimed. Because data were collected at a single time point, the indirect pathway is an associative statistical model rather than proof of temporal or causal mediation; it remains possible, for example, that nurses who adapt well simply perceive more support. Self-reported questionnaires invite recall and social desirability bias, convenience sampling from a single governorate limits generalizability, and some model fit indices were marginal, suggesting the Arabic instrument versions need further validation in larger independent samples. Unmeasured factors—organizational culture, supervision quality, patient complexity, family responsibilities—could also confound the results. Still, as one of the first studies to examine these dynamics specifically among novice home healthcare nurses, the work opens a promising line of inquiry: if resilience can be deliberately cultivated through well-designed educational support, agencies may hold a powerful, testable lever for retaining the next generation of community-based nurses.

Subject of Research: The role of resilience in the relationship between educational support and transition status among novice home healthcare nurses

Article Title: The Indirect Association of Resilience in the Relationship Between Educational Support and Transition Status Among Novice Home Healthcare Nurses

Article References: Amin, S. M., El‐Gazar, H. E., Zoromba, M. A., Mohamed, H. S., Elbakry, M. A. A. E., Mohamed, M. A. A., Atta, M. H. R., Abdelaliem, S. M. F., Baghdadi, N. A., & El‐Ashry, A. M. (2026). The Indirect Association of Resilience in the Relationship Between Educational Support and Transition Status Among Novice Home Healthcare Nurses. Nursing Open, 13(9), Article e70849. https://doi.org/10.1002/nop2.70849

Image Credits: AI Generated

DOI: 10.1002/nop2.70849

Keywords: home healthcare nursing, novice nurses, resilience, educational support, transition to practice, structural equation modeling, job demands-resources model, nursing education, Egypt, burnout prevention, occupational adaptation, cross-sectional study

The research team, led by Veronique Pierrat of the EPIPAGE-2 consortium together with Marie-Aline Charles and Pierre-Yves Ancel, interviewed the parents of 2,181 children born between 24 and 34 weeks of gestation and 7,236 children born at 37 to 40 weeks. The telephone interviews, conducted between February and September 2022, used identical protocols for both cohorts, allowing direct comparison between children born early and their term-born peers growing up in the same country in the same year. Because EPIPAGE-2 had already assessed these children at two and five years of age, the investigators could also trace how support needs evolved across childhood, a longitudinal perspective that few studies of preterm outcomes have managed to achieve at this scale.

On the surface, the ten-year picture is encouraging. Roughly 80 percent of parents of preterm children described their child as being in good health, and 96 percent of children born preterm were attending mainstream classes in mainstream schools, a figure the authors interpret as evidence that France’s inclusive education policy, enshrined in law in 2005, has largely succeeded in keeping these children integrated. About two-thirds of parents reported no difficulties with their child’s emotions, behaviour or relationships. Yet the headline numbers conceal a gradient of difficulty that tracks closely with how early a child was born, and even children born only moderately preterm, at 32 to 34 weeks, were not spared.

Behavioural difficulties, measured with the well-validated Strengths and Difficulties Questionnaire using a cut-off above the 90th percentile of the reference distribution, affected 16 percent of children born preterm compared with 12 percent of those born at term, a difference that remained statistically significant after adjustment. Emotional symptoms were the most common domain of difficulty, affecting about a quarter of preterm children, followed by hyperactivity and peer problems, both of which were significantly more frequent than in the term-born group. The differences between the three gestational age groups within the preterm cohort were not statistically significant, suggesting that behavioural vulnerability extends across the entire spectrum of prematurity rather than being confined to the most extreme cases.

The use of developmental healthcare told a starker story. Overall, 37 percent of children born preterm were receiving developmental healthcare, educational support, or both at age ten, compared with 20 percent of children born at term. Among the most immature group, born at 24 to 26 weeks, that figure climbed to 55 percent. Even among children born at 32 to 34 weeks, a group often considered low risk, 33 percent were receiving some form of developmental or educational assistance. Speech therapy was the single most common service, used by nearly 19 percent of preterm children, followed by psychological or psychiatric care, psychomotor therapy, occupational therapy and orthoptic treatment. After adjusting for maternal age, education, employment, socioeconomic status, family structure, child sex and other social factors, every gestational age group still showed a significantly elevated risk of behavioural difficulties and service use relative to term-born children, indicating that the excess burden cannot be explained by social disadvantage alone.

Schooling data reinforced the same pattern. Although mainstream placement was nearly universal, the proportion of children whose grade level was delayed for their age rose steeply with decreasing gestational age, from 4 percent among those born at 32 to 34 weeks to 16 percent among those born at 24 to 26 weeks, compared with just 3 percent of term-born children. Educational support, defined broadly to include grade retention, personalised schooling plans, professional support assistants and special education settings, was received by 23 percent of the preterm group overall, ranging from 35 percent in the most preterm children to 20 percent in the moderately preterm group, against 12 percent of term-born children. Parents’ own assessments echoed these findings: for children in mainstream classes at the expected level, around 70 percent of preterm parents reported no difficulties in French or mathematics, compared with 80 percent of term-born parents.

Perhaps the most striking findings concern the quieter dimensions of childhood that rarely appear in medical charts. Children born preterm were significantly less likely to participate in sports, with 69 percent taking part compared with 77 percent of term-born children, a gap that persisted after adjustment for social context. They were also less likely to have had a birthday party organised for their most recent birthday, and markedly less likely to have been invited to sleep over at a friend’s house in the previous twelve months, with only 54 percent of preterm children reporting a sleepover compared with 63 percent of term-born children. These differences were concentrated among children with behavioural difficulties or those receiving educational support, and they matter because peer activities such as parties and sleepovers are building blocks of social competence, self-confidence and well-being during the transition from primary to secondary school.

The longitudinal analysis added a sobering dimension to the service-use data. Among children who were receiving developmental healthcare or educational support at age five, 57 percent were still receiving such support at age ten, indicating that for most children who need help early, the need does not simply resolve. More unexpectedly, 28 percent of children who had no support at age five were receiving support by age ten, meaning that a considerable share of difficulties either emerged or were only recognised after school entry. This pattern challenges the standard practice in many countries, including France, of recommending routine long-term follow-up for preterm children only until two to five years of age, depending on gestational age. Difficulties that surface in pre-adolescence, the authors note, may evolve into chronic conditions precisely because they escape the window during which surveillance is typically maintained.

Parents’ perceptions added yet another layer. Around 20 percent of parents of preterm children reported that their child had significant or serious difficulties with emotions, behaviour or relationships, and 14 percent of parents of children born at 24 to 26 weeks said their child needed assistance with usual activities because of a health condition, compared with 4 percent of parents of children born at 32 to 34 weeks. The authors argue that these perceptions are not merely subjective noise but a legitimate measure of family burden, since nearly 40 percent of the preterm group was receiving some form of developmental or school support, a load that inevitably shapes household routines, finances and parental well-being. Previous research cited in the paper suggests that around 20 percent of mothers experience mental health difficulties in the first two years after a very preterm birth, and little is known about how long those symptoms persist.

The study’s authors are careful to acknowledge its limitations, including attrition, since only about half of surviving preterm children and 53 percent of term-born children completed the ten-year interview, and the children lost to follow-up tended to come from more disadvantaged families and, within the preterm cohort, to have had more severe neurodevelopmental disabilities at age five. Weighted analyses and multiple imputation were used to mitigate this bias, but the authors caution that overall rates of difficulty may still be underestimated. Reporting bias is also possible, since all data came from parental interviews, although the team deliberately framed the study around parental perceptions as an outcome in their own right. Even so, the convergence of these findings with earlier work, including Finnish register data showing elevated rates of mental and neurodevelopmental disorders in preterm children and British EPICure studies documenting persistent difficulties at 11 years, leaves little doubt that the challenges are real. The authors conclude that follow-up recommendations should be individualised according to the child, the family and social circumstances, that follow-up networks should cooperate with adolescent-age services, and that health and education systems must work together to support children born preterm through the vulnerable transition into adolescence.

Subject of Research: Long-term neurodevelopmental, educational, social and behavioural outcomes at age ten in children born preterm, assessed in the French EPIPAGE-2 and ELFE national cohorts.

Article Title: Outcome at ten years of children born preterm: the EPIPAGE-2 and ELFE cohort studies

Article References: Pierrat, V., Marchand-Martin, L., Benhammou, V., Gire, C., Kaminski, M., Marret, S., Muller, J.-B., Pavicic, L., Twilhaar, S., Charles, M.-A., & Ancel, P.-Y. (2026). Outcome at ten years of children born preterm: the EPIPAGE-2 and ELFE cohort studies. eClinicalMedicine, Article 104154. https://doi.org/10.1016/j.eclinm.2026.104154

Image Credits: AI Generated

DOI: 10.1016/j.eclinm.2026.104154

Keywords: preterm birth, EPIPAGE-2, ELFE cohort, neurodevelopment, behavioural difficulties, educational support, developmental healthcare, social participation, parental perceptions, age ten outcomes, inclusive education, longitudinal cohort study